HOLLAND COLLEGE OF ARTS & MEDIA SUMMER CAMP REGISTRATION FORM Log In         


The Conservatory Dance Intensive

Please complete all registration fields:
Payment is due at time of registration. If you would like to pay by check or cash please contact Christina Essner 573-651-2652.
 
Participant Name Last:   First:   Preferred Name:
Mailing Address:  
City:   State:   Zip Code:  
Contact Number (home/cell):   Email:  
Gender:   Date of Birth:  
Current School:   Graduation Date:  
Parent/Guardian Name:   Parent/Guardian contact number:   Parent/Guardian Email:  
 
Emergency Contact Information::
Name:   Phone:   Relationship:  
Medications you take for current medical conditions (asthma, allergies, etc.)  
Allergies: Food, Drugs, Insect Stings/Bites, or Other?  
Dietary Restrictions  
Roommate Request  

Camp Cost:

 

Studio Name, City, State
 
How long have you been studying dance?
 
What previous summer programs have you attended?
 
Please identify you’re skill level in Ballet according to the following scale: 0= no experience, 1= beginning, 2= intermediate, 3= advanced
 
Please identify you’re skill level in Pointe according to the following scale: 0= no experience, 1= beginning, 2= intermediate, 3= advanced
 
Please identify you’re skill level in Modern/Contemporary according to the following scale: 0= no experience, 1= beginning, 2= intermediate, 3= advanced
 
Please identify you’re skill level in Jazz according to the following scale: 0= no experience, 1= beginning, 2= intermediate, 3= advanced
 
Please identify you’re skill level in Hip Hop according to the following scale: 0= no experience, 1= beginning, 2= intermediate, 3= advanced
 
Please identify you’re skill level in Aerial (silks/trapeze/hoop) according to the following scale: 0= no experience, 1= beginning, 2= intermediate, 3= advanced
 
Please upload a video of you dancing ballet, modern/contemporary/lyrical, or jazz. Max length of 2 minutes. This video is not required for attendance. It is used solely for class placement. Be sure to use the following criteria for your video: Video must be Public or Unlisted, Private links or videos will not be accepted or viewed; Max Length: 2 minutes; Include a ballet grande allegro with large jumps/leaps and turns; Include a jazz or contemporary combination
 
Would you like to use this summer intensive as an audition into Southeast Missouri State University’s Conservatory Dance Program?
 
Cancellation Policy:
In the event that the University would need to cancel your designated camp a full refund will be returned back to participant and/or family in the form of a University check. In the event that you the participant and/or family will need to cancel your registration from your designated camp, you will receive a full refund up until 4 weeks from the camp. If you cancel within 4 weeks of the camp you will receive partial refund. **Partial Refund is a $50 loss from your camp registrations cost.