*Student's Name

*Age (12 - 16)     Grade      School attended if in Houston 

*Gender Female Male

Ethnicity African American Asian American Latino/Hispanic Native American Caucasian Multi-Racial Rather not specify

*Parent/Guardian's Name

*Phone Number   Alt. Phone Number 

*Street Address

*City   *State    *Zip 

*E-mail Address        Join Mailing List

How did you hear about Young & Intense? 

What level of dancer is the student?  Beginner (0-1yr experience) Intermediate (1-3 yrs experience) Advanced (3+ yrs experience)

Please indicate if the student has any special dietary needs