Motion41 Dance
2017 Summer Intensive
Application

Student's Name: _________________________________________________________________

Gender:  ____  Female                ____ Male

Date of Birth:  _________________________  Age (as of 6/12/17):  _______

Address:  _______________________________________________________________________
           _______________________________________________________________________

Mother's Name: __________________________ Father's Name: __________________________

Parent's Cell Phone #: _____________________________________________________________

Parent's Email Address: ____________________________________________________________

I would like communication via:  __  email     __  phone

Please indicate your participation:    ____  Full 2 Week Program
                                                             ____  1 Week (June 12-17)
                                                             ____  1 Week (June 19-23)
                                                             ____  Single Days or Single Classes (please list dates below)
                                                                                 ___________________________________________
                                                                                 ___________________________________________
                                                                                 ___________________________________________
                                                                                 ___________________________________________

I will require dormitory housing during Summer Intensive  __ yes    __ no

* Current Motion41 Dance students are exempt from completing the Current Training and Previous Training sections
**  Dancers who attend a live audition 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
Name of School
City, State
Primary Teachers
Genres studied
# of dance hours/week
         
         
Name of School
City, State
Primary Teachers
Genres studied
# of dance hours/week
         
         
         
         
Motion41 Dance Summer Intensive 2017 Application  (Pg 2)

Mandatory Placement Classes will take place on June 12th.  Class placement is at the discretion of the Guest Faculty and
Motion41 Dance's Directors.  
If you are not attending the program on June 9th, 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, 2017.

All Tuition balances must be paid by June 9, 2017.  
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.

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



* $25 application fee is not applied to the tuition total for dancers taking Single classes.  The $25 application fee is in addition to the   
   class fees for dancers taking Single classes.