DMDSI Registration

Detroit Male Dance Summer Intensive

First Name (Required)

First Name

Last Name (Required)

Last Name

E-mail (Required)

E-mail

Date of Birth (Required)

Date of Birth

(MM/DD/YYYY)

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Years of Dance Training (Required)

Years of Dance Training

Street Address (Required)

Street Address

City (Required)

City

State (Required)

State

ZIP (Required)

ZIP Code

Cell Phone (Required)

Cell Phone

Best Number At Which To Reach You

Parent/Guardian Name (Required)

Parent/Guardian Name

Parent/Guardian's Phone Number (Required)

Parent/Guardian's Phone Number

Parent/Guardian Email Address (Required)

Parent/Guardian Email Address

Guidelines and waiver forms will be sent to parent and student for signatures.

Emergency Contact (First and Last Name) (Required)

Emergency Contact Name

In addition to your parent/guardian, who should be contacted if there is an emergency?

(Required)

Emergency Contact's Phone Number

I confirm that the information submitted in this form is true, accurate and complete.