Mini Momentum Registration Form
REGISTRATION DEADLINE: January 9th 2022 (to give us time to get shirts ordered for the performance)

This program serves as a fundraiser for our program, so we ask for a $50 donation to cover a T-shirt for the dancers as well as support our dance program and cover show expenses.

West Park High School's Momentum Dance Company would like to invite you to register for our 2022 Mini Momentum Dance Program.

The program is for any student interested in dance K-8th grade.

The program consists of 2 workshops, a dress rehearsal, and a performance.

Workshops: Tuesday, February 8th and Tuesday, February 15th from 4 to 6 pm in the West Park Dance Room (P103).

Dress Rehearsal: Tuesday, February 22nd from 6 to 7 pm in the West Park Gym.

Performance: Friday February 25th from 7 to 9 pm - Mini Momentum dancers will be featured in our first annual Dance Company Concert "Live in the Momentum" Dancers will arrive to the dance room at 6:30 pm 30 minutes prior to the show. Dancers will wear their black leggings/joggers and their Mini Momentum T-Shirts for the performance. They will perform at the very beginning of the show and will be brought out to a reserved section in the audience to watch the remainder of the show for free. You will be able to pick them up from that section of the audience either at intermission or at the end of the show.

Thank you for your support!

Jamie Child
West Park Dance
Jchild@rjuhsd.us
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If you have multiple children who will be participating, please complete the form for each child. Thanks!
Click the below to access our release form. Please print and complete this form. It will be required for admittance into the first day of the workshop.
https://docs.google.com/document/d/1DAEATkUfifKgtagt8C0h8XrfBtraTdd1hIq1zR9N5t8/edit?usp=sharing
Click the below to access our release form. Please print and complete this form. It will be required for admittance into the first day of the workshop.
https://docs.google.com/document/d/1DAEATkUfifKgtagt8C0h8XrfBtraTdd1hIq1zR9N5t8/edit?usp=sharing
Dancer's Last Name *
Dancer's First Name *
Parent/Guardian #1 Last Name *
Parent/Guardian #1 First Name *
Parent/Guardian #1 Relation to Dancer *
Parent/Guardian #1 Phone Number *
Parent/Guardian #1 Email Address *
Parent/Guardian #2 Last Name
Parent/Guardian #2 First Name
Parent/Guardian #2 Relation to Dancer
Parent/Guardian #2 Phone Number
Parent/Guardian #2 Email Address
Dancer's Grade Level *
Dancer's T-Shirt Size *
Dancer's Food Allergies (put NA if none) *
Other Important Medical Information (put NA if none) *
Emergency Contact Information
Emergency Contact Last Name *
Emergency Contact First Name *
Emergency Contact Phone Number *
Emergency Contact Relation to Dancer *
Authorized Pick Up Persons other than parent/guardians/emergency contact *
Insurance Company *
Medical Number *
Physicians Name *
Physicians Phone Number *
Click the link below to pay for the workshop. When the page comes up click "Send" and for the amount please enter $50. Then click "Continue" to complete your payment.
https://paypal.me/WPHSDanceBooster?country.x=US&locale.x=en_US
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