*If entering multiple Crews, one registration form must be filled out for each Crew. The Contact Person for each Crew must be 18 years of age or older and can sign on behalf of the crew by checking off the box below.

CONTACT PERSON FOR CREW

Name: Name of Crew/Studio:

Position (Choreographer, Teacher, Manager, Dancer etc.):

City: Phone #: E-mail:

CREW INFORMATION

Number of Dancers in Crew:

*In the table below please provide the names, ages, date of births and UDO Membership #’s for all crew members.

CLASSIFICATION: Newcomer/Intermediate

Under 10  Under 14  Under 18 

CLASSIFICATION: Advanced

Under 10  Under 14  Under 18 

CLASSIFICATION: Open

Over 18 

By registering I on behalf of the parties registered, my crew/studio fully understand that Street Dance Canada Inc., Canadian Street Dance Championships staff members, volunteers and the host venue are not liable for any personal injuries, loss, or damages sustained while attending the aforementioned event. I authorize Street Dance Canada Inc. the use of photographs or videos of myself, my work and my dancers for advertising purposes and promotions for any future Canadian Street Dance Championships with or without the use of name, crew/studio name, or dancer’s names. I understand that if I choose to withdraw from the competition that there are no refunds. I agree that Street Dance Canada Inc. reserves the right to make changes to the competition venue and/or schedule without notice. NAME: DATE:

Please have all forms and payments submitted by February 28, 2013. For multiple entrees, you have to fill in an entry summary sheet as well. Forms can be emailed to: or send to: UDO Street Dance Canada, 12 Bram Court, Unit 5, Brampton, Ontario, L6W 3V1

CREW/STUDIO NAME:______

Dancer’s NAME / Date of Birth mm/dd/yyyy / Age as of Feb 1st 2013 / UDO Membership #
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