Benicia Ballet Theatre's Summer Dance Workshop & Performance Application

To complete this form you will be paying the $25 registration fee.

Dancer's First Name

Dancer's Middle Initial

Dancer's Last Name

Dancer's Birthdate

Gender

Dancer's Email

Dancer's Phone

Street Address

City and State

Zip code

PARENT/GUARDIAN INFORMATION

Parent/Guardian Name

Parent/Guardian Phone

Address if different from Dancer's

Parent/Guardian Work Phone

Parent/Guardian Home Phone

Parent/Guardian Email

EMERGENCY CONTACT INFORMATION

Emergency Contact Name

Emergency Contact Cell Phone

Emergency Contact Work Phone

Relationship to Dancer

Emergency Contact Home Phone

DANCE DIVISION

Age Division

Cost ages 3-7: $100

Cost ages 8+: $200

"By submitting this form, I understand that I am required to complete the 2019-2020 Medical Consent and General Information form before classes begin, and pay a $25 registration fee."

*Students of Benicia Academy of Performing Arts and Dancer's particpating in the 2019-20 season do not need to complete additional forms or registration after this is completed.

Thank you for registering your dancer!

Click here to pay remaining Summer fees