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Imagination Celebration presents

The 9th Annual Debbie Allen Dance Institute

Registration Application
Placement Auditions Sunday, June 17th, 2007
Classes Daily 9:00 - 4:00 Monday - Saturday, June 17 - 30, 2007


Student's Name ____________________________________________________________

Address __________________________________________________________________

_________________________________________________________________________

City _______________________________________ State____________ Zip Code____________

Phone# (____) _____________________ Age___________(7 - 21 only) M__ F__

Last School Attended ______________________________________________ Grade ________

Are you a returning student from the Institute? _____ Yes _____ No

How did you hear about the Institute? __ Letter, __ Poster, __ Friend,

__ Dance Studio - Name _______________________________,

__ Other - Describe _______________________________

Name of Parent/Guardian ________________________________________________

Phone________________________ Wrk Phone________________________ Mobile ____________

Person to call in the event of an emergency ________________________ Phone ________________




Tuition $500.00 + $25 Application Fee = Total $525.00
 A $100.00 deposit and $25.00 non-refundable application fee must accompany each completed Registration Application no later than Monday, May 1, 2007. Tuition balance of $400.00 is due June 17, 2007.

Please make check or money order payable to Imagination Celebration Fort Worth. Mail to ICFW at 1300 Gendy, Fort Worth, Texas 76107. To pay by Credit Card please call our office at (817) 870-1141.

Include photo if available.

Space is Limited. Applications received after deadline will be accepted as space permits.

Students with outstanding balances will not be admitted.

I grant Imagination Celebration Fort Worth permission to use, publish and display for any legal purposes in order to provide information about ICFW, any or all photographs, videos or descriptive text in which I or the Minor(s) who I am responsible for appear(s).

Signature of Parent/Legal Guardian

_______________________________________ Relationship ____________________







For office use only:




____ Completed Registration Form _____ $25 Application Fee ___ $100 Deposit (applied to tuition)

Received __________________________




Mailing Address:
Imagination Celebration Fort Worth
1300 Gendy
Fort Worth, TX. 76107


Telephone
(817) 870-1141


Fax
(817) 336-7947