Bring It To Broadway Registration Form

Page 1

Todays Date: Name:

MM

DD

YY

Birth Date:

MM

DD

YY

First

Last

Age: (As of 7/30/2012)

Voice Type: (circle one)

Soprano

Alto

Tenor

Baritone

Bass

Sex:

(circle one)

Rate your proficiency level: 1 = Beginner 2 = Intermediate 3 = Advanced Acting: 1 2 3 Singing: 1 2 3

(circle one for each category)

Dancing: 1

List years studied for each:

Acting

Singing

Dancing

Ratings and experience will provide instructors the ability to assess your audition and class placement. Please be honest!

Parent/Guardian Name:

First

Last

Home Phone:

Cell Phone:

Work Phone:

Address:

Street

Apt. #

City

State

Zip Code

Email Address: Emergency Contact Name:

First

Last

Emergency Contact Phone Number:

Relation:

All classes will take place in the studios of The Art Underground and Dana V. Music, 901 Front Street, Louisville, CO.

Registration Deadline: July 1, 2012

Mail Registration Form, Tuition Form and Payment to: Dana V. Music, 901 Front Street, Suite B150, Louisville, CO 80027 Make checks payable to: Dana V Music
Dana V Music * Mailing Address 901 Front Street, Suite B150, Louisville, CO 80027 * (303) 974-5586 * www.danavmusic.com

Tuition Sheet

Page 2

Courses Camp
Audition Workshop: July 30, 10:00 am - 12:00 pm Camp: July 30-August 4, 12:30 - 6:00 pm Final Presentation: August 4, Time TBA

Cost $300

Pay $

Adult Workshop
Ages: 18 and up August 1, 7:00 - 9:00 pm

$50

Private Lessons
I am interested in taking a private lesson in: Voice Dance Lessons will take place July 31-August 4 between 10:00 am and 12:00 pm. Scheduling will be done separately and is first-come, first-serve.

Call for Price

Prices for each instructor will vary and be paid to instructor separately. Please call DVM at (303) 974-5586 for pricing.

Registration Deadline: July 1, 2012

Add items in right column

Total Paid

Special Note: Once registration form and payment are received, you will be contacted by a representative of Bring it to Broadway and will be sent a welcome letter noting audition materials, supplies for camp, medical form, and schedule information. All classes will take place in the studios of The Art Underground and Dana V. Music, 901 Front Street, Louisville, CO.

Liability Release- Please Read Carefully:

I agree to indemnify and hold harmless Dana V. Music, its officers, employees, agents, consultants, subcontractors, insurers and representatives (collectively Dana V. Music), for any loss, damage, or injury to myself or my property in any way related to my participation in Dana V. Music's programs. This release of Liability applies to me as well as any of my children, personal representatives, assigns, heirs, and next of kin. I authorize Dana V. Music in a medical emergency to seek emergency medical assistance at my expense. Signature of Participant (parent or guardian) Date

I give permission to Dana V. Music to use any photographs, videotape, or other media record of my participation in Dana V. Music Programs for any lawful purpose, without compensation.
Signature of Participant (parent or guardian) *Information provided here is for Dana V. Music use only. We do not share information with outside sources. Date

OFFICE USE ONLY: Payment Type: Intake Initials: Database Initials:

Amount: Date: Date:

Registration Deadline: July 1, 2012

Mail Registration Form, Tuition Form and Payment to: Dana V. Music, 901 Front Street, Suite B150, Louisville, CO 80027

Make checks payable to: Dana V Music

Dana V Music * Mailing Address 901 Front Street, Suite B150, Louisville, CO 80027 * (303) 974-5586 * www.danavmusic.com