Official Entry Form
1st Annual Dance Crew Battle Championship Saturday July 18, 2009 6:00 PM
Event Location / Locust Lounge 205 E. 2nd St. Pomona, Ca.
Entry deadline July 10, 2009
(entries received after July 10, 2009 will incur a $10.00 Late fee per crew)
Please fill out the following form completely. An entry form must be completed and signed by each crew member.
Name __________________________________________________
Date of Birth__________________
Address_____________________________________________________________________________
City_____________________________________________
State ____________ Zip ______________
Email_____________________________________________ Phone____________________________
Coach/Manager: Name _______________________ Phone:_________________ Email:_____________
Crew Name ___________________________________________________________
( Crews will be announced and identified by their crew name.)
Please list crew members names and their age they will be on the day of the competition
1. _______________________________ Age _____
2. _______________________________ Age_____
3. _______________________________ Age _____
4. _______________________________ Age_____
5. _______________________________ Age _____
6. _______________________________ Age _____
7. _______________________________ Age _____
8. _______________________________ Age _____
Registration Fee: $50.00 (Registration fees are non refundable.) At The Door Registration $75.00
Registration fees paid by: Cash _____ Check _____ Money Order _____
Mail entry forms to: Summer Mayberry / 7 Underground -
2307 Riverwood St. Colton, Ca. 92324
Or
Drop off in Person: Locust Lounge 205 E. 2nd St. Pomona, Ca.
(Wednesday’s Only) 7 PM to 9 PM. Call before going
When you arrive there ask for Summer.
Phone: 951-334-8319 Email: blondybear03@aol.com
Registration Fees paid cash / in person will receive $5.00 off their registration fees.
WAIVER:
In consideration of the acceptance of my entry, I the undersigned am legally bound, for myself, my heirs successors and assigns do hereby waive and release Summertime Entertainment,
7 Underground, sponsors, host venues and all persons and agencies connected with this competition from all claims for damages arising from my participation in and travel to and from this competition, including without limitation personal injury. I certify that I am in good health, physically fit and adequately trained to participate in this event. I grant permission to all the above mentioned to use my name and likeness for any purpose.
_________________________________________________________________________________
Signature of participant ( 18 and over ) Date
_________________________________________________________________________________
Signature of Parent / Guardian for participant under 18 Date
For more information Call 951-334-8319
