Motion41 Dance
2012 Summer Intensive
Application
2012 Summer Intensive
Application
Student's Name: _________________________________________________________________
Gender: ____ Female ____ Male
Date of Birth: _________________________ Age (as of 6/11/12): _______
Address: _______________________________________________________________________
_______________________________________________________________________
Mother's Name: __________________________ Father's Name: __________________________
Parent's Cell Phone #: _____________________________________________________________
Parent's Email Address: ____________________________________________________________
I would like communication via: __ email __ text message __ phone
Please indicate your participation: ____ Full 2 Week Program
____ 1 Week (June 11-16)
____ 1 Week (June 18-22)
____ Single Days (please list below)
_________________________
_________________________
_________________________
_________________________
Current Motion41 Dance students are exempt from completing the Current Training and Previous Training sections
Current Training
Previous Training
Have you attended Summer Programs before? __ yes __ no If yes, program: ______________________________________
This Application must be accompanied by the following before it can be processed for acceptance:
1) $25 Application Fee by check or money order payable to Motion41 Dance. This fee is
non-refundable, but if you are accepted it will be applied to your tuition total.
2) 3 photos, 4x6 each on photographic paper
a) Head shot: close-up, full face, preferably with hair up
b) Tendu in second position, arms in second position
c) First arabesque, on releve (on pointe if applicable)
* Dancers should wear a leotard and tights in the photos (no skirts, shirts, legwarmers, etc.)
* Current Motion41 Dance students are exempt from the photo requirements
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Motion41 Dance Summer Intensive 2012 Application (Pg 2)
Mandatory Placement Classes will take place on June 11th. Class placement is at the discretion of the Guest Faculty and
Motion41 Dance's Directors. If you are not attending the program on June 11th, you must prearrange to take a class with one of the
guest faculty on your first day at the program.
50% of your tuition total is due on or before May 1, 2012.
All Tuition balances must be paid by June 1, 2012. Dancers with an open balance will not be permitted to take class.
Tuition is completely non-refundable. If a dancer becomes injured or ill and has a doctor's note, a credit to Motion41 Dance will
be issued. The only instance when a refund will be issued is if tuition paid exceeds the amount for the program in which a
dancer is participating in after the Placement Classes on June 11th.
Surcharges:
Any student submitting an Application or Payments after May 1st will be charged the following:
- An additional $100 for 1 Week or 2 Week participants
- An additional $50 for Single Day participants
- An additional $25 for Single Class participants
By Signing below, you acknowledge that you understand and agree to the policies stated in this application. You also release
Motion41 Dance or any of its instructors (guest teachers or otherwise) from any and all liability in the event that the student
becomes injured or ill while participating in the Summer Intensive or any of its related activities.
________________________________________________________________________________________________________________
Signature (must be parent or guardian if the student is under the age of 18)
Send this Application and all required enclosures to:
Motion41 Dance
2819 S. 125th Ave., Ste. 256
Omaha, NE 68144
Mandatory Placement Classes will take place on June 11th. Class placement is at the discretion of the Guest Faculty and
Motion41 Dance's Directors. If you are not attending the program on June 11th, you must prearrange to take a class with one of the
guest faculty on your first day at the program.
50% of your tuition total is due on or before May 1, 2012.
All Tuition balances must be paid by June 1, 2012. Dancers with an open balance will not be permitted to take class.
Tuition is completely non-refundable. If a dancer becomes injured or ill and has a doctor's note, a credit to Motion41 Dance will
be issued. The only instance when a refund will be issued is if tuition paid exceeds the amount for the program in which a
dancer is participating in after the Placement Classes on June 11th.
Surcharges:
Any student submitting an Application or Payments after May 1st will be charged the following:
- An additional $100 for 1 Week or 2 Week participants
- An additional $50 for Single Day participants
- An additional $25 for Single Class participants
By Signing below, you acknowledge that you understand and agree to the policies stated in this application. You also release
Motion41 Dance or any of its instructors (guest teachers or otherwise) from any and all liability in the event that the student
becomes injured or ill while participating in the Summer Intensive or any of its related activities.
________________________________________________________________________________________________________________
Signature (must be parent or guardian if the student is under the age of 18)
Send this Application and all required enclosures to:
Motion41 Dance
2819 S. 125th Ave., Ste. 256
Omaha, NE 68144