2x2

Male Pic

2x2
Female Pic

------------- OFFICIAL ENTRY FORM ------------Male

Female

Name:__________________________________________
Age:___________________________________________
Address:________________________________________
Date of Birth:____________________________________
E-mail:_________________________________________
Contact Number:_________________________________

Name:__________________________________________
Age:____________________________________________
Address:_________________________________________
Date of Birth:_____________________________________
E-mail:___________________________________________
Contact Number:__________________________________

-------------------------------Please check the events that you wish to enter----------------------------

CATEGORY

LATIN

STANDARD

Juvenile 2 (11 years old and below)

C, J
W, T
-------------------------------Please check the events that you wish to enter---------------------------Juvenile Close
C, J
Juvenile 3 (11 years old and below)
C, S, J
Juvenile
STANDARD
Junior
3( 212(11
-15years
years old and below)
C, S, J
old and below)
Junior 4 (12- 15 years old and below)
C, R, S, J
Juvenile Close
Open
W, T, Q
Juvenile 3 (11 years
Amateur
C, R, S, Pd, J
old and below)
CERTIFICATION AND WAIVER
Junior 3( 12 -15
We certify that all information entered herein is correct and accurate, and shall be the basis for the qualification and
years old and
approval of our participation in the appropriate competition event(s) we have registered for. We further certify that we have read
below)
the official rules of the competition and shall abide by the final decision of the organizer based on the rules. We hereby absolve
Junior
4 (12-of
15any obligation for any injuries, damages, losses we may sustain throughout the course of the participation and
the
organizer
years
old
and
conduct of this event.
below) Male Signature____________________________________
Female Signature______________________________
Open
_______________________________________
_______________________________________
Amateur
Parents/Guradian Signature Over Printed Name
Parents/Guradian Signature Over Printed Name

CATEGORY

ENTRY FEE:

Juvenile
Junior
Open Category
Amateur

Php 300.00
Php 400.00
Php 400.00
Php 500.00

Submit your entries to:

29 May 2014 9:00-4:00 P.M.
Mr. Zaheedon Hussain
SUMMER DANCE CONGRESS
Email: dc2xyle_dancesportteam@yahoo.com
2014
[subject: 2ndMWDC Entry Form]
Cell No.09305209125
Please attach a machine copy of your birth certificate