Registration

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: * Zip: *
Emergency Contact Info*
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Student Phone Number*
Height & Weight*
T-shirt Size *
Will you need a host home?*
Current dance studio attending?*
Current dance schedule and hours of training?*
How many years of dance training?*
Years on pointe:*
Are there any injuries or health concerns that may prohibit you from dancing to the fullest?*
How did you hear about EncounterPAC?*
Church name and denomination:*
Personal Testimony - please describe your relationship with the Lord and how Jesus Christ became your personal Lord and Savior.*
What are your future goals and plans?*
Why do you want to be a part of the EncounterPAC Elevate Company?*
 
Additional Information:
 
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*