Spring dance clinic registration
Thanks for utilizing our online registration form. When submitted, your should receive a confirmation (email or phone) within a day or two.

**NEW--you can pay online using RevTrak!  Link is on our school district homepage and will be on the confirmation page when you submit this form. (Small service fee applies to the online transaction.)

If you do not pay online, please bring your registration fee to the clinic, do NOT send to your dancer's school.  
$15 per dancer IF she attended our January clinic (has a coral dance clinic t-shirt to wear for performance)
OR $25 per dancer who did NOT attend January clinic (needs to order a coral dance clinic t-shirt)

We look forward to working with your dancer!
Sign in to Google to save your progress. Learn more
Dancer's first and last name *
Dancer's current grade *
Parent/guardian first and last name *
Parent/guardian phone number *
Parent/guardian email (for clinic registration confirmation and clinic/performance-related info only)
Payment options (NEW--RevTrak is available to pay your clinic fee!) *
*IF DANCER DID NOT ATTEND JANUARY CLINIC: Dancer's t-shirt size (regular youth or adult tees, Hanes/Gildan/Jerzees style)
Dancers who attended our January clinic do NOT need to answer this question--just wear or bring your coral clinic t-shirt.
Clear selection
Additional dancer(s) registering with the dancer listed above?  Please list here:  Dancer's first/last name, current grade,**T-SHIRT SIZE IF NEEDED**, parent/guardian contact info (if different)
*Please double-check with additional registrants about January clinic attendance/t-shirt needs!
By submitting this registration form, I give my approval for my dancer's participation in any and all activities of the dance clinic and acknowledge that she is physically able to participate. I understand that the Smith-Cotton staff and school are not responsible for accidents resulting in medical expenses or other expenses including loss of personal items.
I also authorize photos and videos taken during the clinic/performances.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Sedalia School District #200. Report Abuse