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Feature your CDA Dancer by celebrating them with a Shining Star ad during our Show week! These Stars will appear in the theater on our big screen before the show, during intermission, and in the lobby AT EVERY SHOW! Each star will include photograph of your dancer with a small congratulations message from you and your loved ones. Shining Stars are available to all performers ages 3yr and up! All Stars are $25.00 each and your card on file will be charged upon submission of this order. You will receive a PROOF of the ad prior to the show weekend. All photos must be emailed to: niki@cummingdanceacademy.com **Please help our design time by turning your information in as soon as possible so that we can begin creating your ad immediately.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
School:
Grade Level:
*
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Questions/Options:
Please list the Dancer Name and Age
*
Please list the class day & time for your dancer including the teacher.
*
Please type in the text you would like to appear on your Shining Star. Short messages will be easily read on a slide show, we suggest one - two lines only.
*
Additional Information:
Payment
(Show-Hide Details)
I understand that my most recent card on file will be charged in the amount of $25.00 upon registering online.
I've read the above and agree.
Show Feature
(Show-Hide Details)
I understand that all Shining Stars will be featured before each show, during intermission, and in the lobby. If for some reason I miss seeing my Shining Star, I agree it will be at no fault of CDA.
I've read the above and agree.
Photograph- copyrights
(Show-Hide Details)
I understand that no copyrighted photo's are allowed without photographers written approval.
I've read the above and agree.
Design
(Show-Hide Details)
I understand I will receive a proof of my ad prior to the show weekend. All ads will be electronically approved.
I've read the above and agree.
Agreement
(Show-Hide Details)
I understand that by submitting my order, I agree to the purchase and terms and conditions listed above.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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