Dance Program

Student First Name *

Student Last Name *

Student Email Address
(Please do not enter parent/guardian email here.) *

Student Cell Phone
(Please do not enter parent/guardian phone here.) *

Gender: How does student identify? *

Male

Female

Non-Binary

Prefer To Self-Describe (please use space below)

Prefer to Self-Describe:

Which pronouns does student prefer? *

Student Date of Birth * +

Not yet 14 years old? Students under the age of 14 are considered on a case-by-case basis. Please email andrea@broadwaytrainingintensive.com to inquire.

Home Address *

City *

State *

Zip Code *

How did you hear about this program?
(Please be specific.) *

High School Name *

High School Graduation Year *

College Name (If Applicable)

If you are currently a high school student or a college student planning on transferring, and you are interested in pursuing a performing arts major in college, please tell us which major(s) you plan to audition for. (Theatre, Musical Theatre, Film, Dance, etc.).
If not applicable, please write "n/a" in the box. *

If student is under 18, the following must be completed for at least one parent/step-parent/guardian. (Optional but encouraged for students who are between 18-21.)

Parent / Step-Parent / Guardian 1 - FIRST NAME

Parent / Step-Parent / Guardian 1 - LAST NAME

Parent / Step-Parent / Guardian 1 - Email Address

Parent / Step-Parent / Guardian 1 - CELL PHONE

Parent / Step-Parent / Guardian 2 - FIRST NAME

Parent / Step-Parent / Guardian 2 - LAST NAME

Parent / Step-Parent / Guardian 2 - Email Address

Parent / Step-Parent / Guardian 2 - CELL PHONE

Emergency Contact - NAME
(Please do not list parents/guardians you've already included above. In the case of an emergency, we will attempt to contact the above parents/guardians first, and if we are unable to reach them we will contact this person.) *

Emergency Contact - RELATION *

Emergency Contact - CELL PHONE *

Is there anything we should know about the student’s health?
Please include injuries, surgeries, asthma, allergies (including food and medication), etc.

If not applicable, please type "n/a" in the box. *

Does student have any mental health, psychiatric, or other medical conditions, we should be aware of and/or that it would help for us to be aware of?

If not applicable, please type "n/a" in the box. *

Does student use an inhaler?
If yes, does the student carry the inhaler with them, and which mediation does the inhaler dispense?

If not applicable, please type "n/a" in the box. *