Entry Form
Please return completed entry form, consent,
and entry fees to:
Pakenham Fiddle and Stepdance
Association
K0A
2X0
Email: contest@fiddleanddance.com
Name: _____________________
Address:_______________________________________
_______________________________________
Postal Code:____________________
Email Address:__________________
Telephone # :___________________
Date of Birth:____________________
Consent for Pictures for Media Promotions of
Event: Yes____No___
Questions:
Who is your teacher?________________________________
What is something you look forward
to doing this summer?___________________________________
What is your favourite pet?____________________________
What is your favourite hobby?________________________
Registration
Pre-registration All Classes - $7.00 / Person
Group Classes - $7.00 (per person in group)
Registration at the door – All Classes - $8.00
/Person
Stepdancing Fiddle
___ 9 & Under ___9
& Under
___12 &
Under Novice ___12
& Under Novice
___12 & Under ___12
& Under
___18 &
Under Novice ___18
& Under Novice
___18 & Under ___18
& Under
___Junior
Group ___70
& Over
___19 – 49 ___19
– 49
___50 &
Over ___50
- 69
___Senior
Group ___Twin
Fiddle
___Open
Class ___Open
Fiddle
Group Name: _________________ Twin Name: _____________
TOTAL
ENCLOSED: $_________________
Please make
cheques payable to: Pakenham Fiddle and Stepdance Association
Important – Please Note: A group consists of 3 to 6
dancers. Twin Fiddle is
considered as a group. All groups must be pre-registered, including
Twin Fiddle.