Registration Form for ADTS Dance Clinic Teams

First and Last Name*

Email*

Current School*

I acknowledge that participation in this clinic involves physical activity and carries inherent risk of injury. By registering my team, I assume full responsibility for the safety and conduct of all participating dancers. I agree to release and hold harmless the UNT Dance Department, North Texas Dance, the University of North Texas, and all clinic staff from any liability, claims, or demands arising from participation in the clinic.

Signature*

I grant permission for all participating dancers to be photographed or recorded during the clinic. I authorize the UNT Dance Department, North Texas Dance, and the University of North Texas to use these images or videos for promotional, educational, and social media purposes without compensation or the right to review or approve the final materials.

Signature*

My Products

Participation Cost

$50.00

	Quantity	Price
Participation Cost (1-10 dancers)		$50.00
10+ Participants Discount (10 or more dancers)		$40.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please verify that you are human*