Summer Clinic Registration

Sun, Aug 17 • 10am-3pm • Fountain Valley High School

Participants must bring their own equipment

$45 non refundable fee - PAY HERE

Fee includes one dance class & one equipment class

Performer's Name

First Name

Last Name

Age

Please list you performer experience

I authorize Vox Artium to edit copy exhibit distribute and use any video or images taken of me during the Vox Summer Clinic

I agree

Pick ONE movement class

Pick ONE equipment class

Advanced Equipment classes will consist of Open/World class skills, 6's or 7's on weapons, 45 tosses, and choreography with multiple planes and lower body contributions. Intermediate Equipment classes will consist of Open/A skills, quads & fives on weapon, 45 tosses & choreography with some lower body contributions. Beginner equipment classes will consist of skills for performers in their 1st or 2nd year spinning.

Medical Release Form + Emergency Contact

Physical or Mental Pre-existing Conditions:

List Any Medications You Are On:

Insurance Provider

Policy Number

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

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I hereby submit this information to the Vox Artium Foundation Inc and entrust them to use this information to the best of their ability in the case of an emergency regarding my wellbeing or the person for whom I am responsible in the event of an emergency all medical bills and/or charges incurred will be the responsibility of the individual members insurance or personal responsibility. Vox Artium & Fountain Valley High School will not be held liable.

I Agree

If under 18:

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Email

Parent/Guardian Phone

(###)

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