Danceworks Covid-19 Youth Class Credit

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* 1. Name of person completing this survey

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* 2. Name of Danceworks student (please submit one form per student)

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* 3. Please list the class that you expected credit for along with the day, time, and location that the class meets.

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* 4. Email Address

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* 5. Home address

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* 6. Credit and/or donation options

I would like to donate my full credit to Danceworks. You will receive an acknowledgement letter for your in-kind, tax deductible donation.

I would like to receive a full credit to be added to my Danceworks account (this credit is good for one year.)

I would like to donate part of my credit.
You will receive an acknowledgment letter for your in-kind, tax-deductible donation.

If you would like to use your credit to make a donation, please specify the amount you would like to donate.

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* 7. Please type your first and last name here along with the date as your Electronic Signature