Individual Registration/Release Form
2024 Summer Event | July 16-21 | Dallas, TX
Tuition: $1,000 | $200 Non-refundable deposit required at time of registration
Contact SE (soulescapethecompany@gmail.com) for any form revisions
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Attendee's First Name *
Attendee's Last Name *
Attendee's Age *
Mailing Address, City, State, Zip
Contact Email Address (We will be sending important event information to email address provided) *
Emergency Contact Name & Relation *
Emergency Contact Phone Number *
I have a Scholarship to apply to my tuition (Original scholarships must be emailed to soulescapethecompany@gmail.com)
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PAYMENT 
Tuition: $1,000 | $200 Non-Refundable required at time of registration
*Full payment is due no later than June 16
*Credit cards will be processed on June 16 unless specified
*Payment plan options available!

I'd like to make the following payment today:
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PAYMENT TYPE
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CREDIT CARD INFORMATION
You may list your cc info below or contact us at 469-585-4095 to provide your information over the phone. We will contact you before processing any payments and receipts will be sent via email.

CC # / Expiration / Security Code / Billing Zip Code
SHOW TICKETS & OTHER IMPORTANT INFORMATION
*All registered dancers receive a FREE ticket to the Company Performance.
*All additional show tickets will be available for purchase beginning July 1.
*Company Performance: July 16  |  Student Performance: July 21

*Classes/Rehearsals will be held at the Marriott at Legacy Town Center July 17-20
*Both Performances will be held at the Coppell Arts Center July 16 & 21

*Sending a check? Mail to the following address:
SoulEscape Productions
9037 Silsby Drive
Fort Worth, TX 76244

*Have Questions? Please don't hesitate to reach out!
soulescapethecompany@gmail.com or 469-585-4095
I, the undersigned, have the authority to sign this release on behalf of all the persons registered above and/or attached for this intensive. Loss/damage of personal property or personal injury of those participating or attending. I also authorize SoulEscape to use images of the registered parties for advertising purposes.
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