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TRANSCRIPT
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Mosaic’s Dancing for Human Rights Championship 2016 Pro/AM Dance Entry Form
Teacher:
Name of Student:
Male / Female (circle one)
Studio: Phone:
Address: City/State/Zip:
Email:
AGE DIVISION: PLEASE CIRCLE
Pre-teen(8-12) Junior(13-16) Adult(17-20) Adult I(21-30) Adult II(31-40) Adult III(41-50) Adult B(51-60) Adult BI(61-70) Adult C(71-80) Adult CI(81-90) Adult D(90+)
ENTRY TYPE
Please Circle: CONTESTED PROFICIENCY
Closed American and International Style Single Dances
Dance Level American Smooth American Rhythm Standard Latin
Newcomer Bronze
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Bronze 1
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Bronze 2
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Bronze 3
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Pre Silver
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Silver 1
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Silver 2
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Silver 3
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Pre Gold
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Gold 1
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Gold 2
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Gold 3
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
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Open American and International Style Single Dances
Dance Level American Smooth American Rhythm Standard Latin
Pre Bronze
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Bronze
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Pre Silver
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Silver
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Pre Gold
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Gold
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Advanced
W T FT VW PB AT CC R ECS B M WCS Sam PD Sal Hus Mer Bac W T VW FT QS CC Sam R PD J
Gentleman:_________________________________ Lady________________________________
Teacher and student must sign forms
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Mosaic’s Dancing for Human Rights Championship 2016 Pro/AM Dance Entry Form
Teacher:
Name of Student:
Male / Female (circle one)
Studio: Phone:
Address: City/State/Zip:
Email:
AGE DIVISION: PLEASE CIRCLE
Pre-teen(8-12) Junior(13-16) Adult(17-20) Adult I(21-30) Adult II(31-40) Adult III(41-50) Adult B(51-60) Adult BI(61-70) Adult C(71-80) Adult CI(81-90) Adult D(90+)
Country Western: Circle Dances and Levels
Dance Level Dances
Pre Bronze Waltz 2step Polka ECS Cha Cha WCS Triple2
Bronze Waltz 2step Polka ECS Cha Cha WCS Triple2
Silver Waltz 2step Polka ECS Cha Cha WCS Triple2
Gold Waltz 2step Polka ECS Cha Cha WCS Triple2
Gold Waltz 2step Polka ECS Cha Cha WCS Triple2
Waltz 2step Polka ECS Cha Cha WCS Triple2
Formations/Group
Please provide a separate sheet with participants names and birthdates
Formation Name Level Dance
Showcase
Solo Name Level Dance
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Championship (No age Division)
Bronze Bronze Smooth Rhythm
Silver and above Silver and above Smooth Rhythm
Gentleman:_________________________________ Lady________________________________
Teacher and student must sign forms