2022 Summer Intensive Video Audition
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 (Not Contact #1 or #2)
Students entered below will be added to your family's account
I am interested in attending Week One of the intensive (July 11-July 15)
I am interested in attending Week Two of the intensive (July 18-July 22)
I am interested in attending Week Three of the intensive (July 25-July 29)
I am interested in attending Week Four of the intensive (August 1-August 5)
What academic school is your child currently attending?
What dance studio is your student currently dancing at?
Is your student on pointe?
If yes, please give the month and year they began their pointe training.
Does your student have any allergies or physical limitations that LABA should be aware of?
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number: *  
Name as it appears on card: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*