Annual Summer Intensive Workshop Registration

Annual Summer Intensive Workshop Dates: July 19-27, 2023

Payment Option

Pay Now
Pay Later

Credit Card Information

Cardholder Name (Required)

Credit Card # (Required)

Expiration Date (Required)

Security Code (Required)

cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

Billing Zip Code (Required)

Cover the fee associated with this online transaction?

Yes, I will pay an additional {transaction_fee} to cover the cost of this transaction.

Cover the fee associated with this online transaction?

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

Dancer's name (Required)

Date of Birth (Required)

Age (Required)

Address (Required)

City (Required)

State (Required)

Zip Code (Required)

Phone (Required)

Email (Required)

Mother's Name (Required)

Mother's Phone (Required)

Father's Name (Required)

Father's Phone (Required)

Years Training (Required)

Studio (s) (Required)

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Dancer's t-shirt size (included in price) (Required)

Registration fee (Current LDB Dancers)
Registration Fee
remaining tuition (Current LDB Dancers)
remaining tuition
Registation fee and Tuition (Current LDB Dancers)
Registration fee and Tuition

Tuition to be paid in full by July 10, 2023

Release:

I (We), the undersigned dancer parent or legal guardian to a dancer at the workshop held by Louisiana Delta Ballet, do voluntarily and knowingly execute this release with the expressed intention of effecting the extinguishment of and complete release from any and all claims, actions, demands or rights to monetary judgment arising from any and all injury or physical harm which may arise from or be sustained as a result of my participation or the participation of my child and/or legal ward in various programs of instruction, practice and physical activity associated with the study of dance and related activities at the workshop held at the Monroe Civic Center Convention Center and Missy Crain Dance Studios.

Signature of Parent or Guardian (Required)

Signature of Student (18 years or older) (Required)

Date (Required)