Coastal Carolina Dance Clinic

Kindergarten - 8th grade
Saturday, February 15, 2014 - TIME: 3-5 p.m. - HTC Center

  • Cost $40.00 (only $30.00 if registered before February 4th)
  • Cost includes clinic, t-shirt and child's admission to the CCU basketball game vs. Gardner-Webb
  • Clinic participants will perform with Coastal Chicks Dance Team during halftime of the basketball game.
  • Additional basketball tickets in the FanZone sections are $10.00 for adults, $8.00 for youth under 18.
  • Tickets in the Bronze section are $12.00 for adults, $8.00 for youth under 18.
  • Payment due at Clinic or by contacting Audra Scofield at 843.349.2887.

Make checks payable to Coastal Chicks Dance Team
Should you have any questions please contact Audra Scofield at 843.349.2867 or

Please complete the following form:

Participant's Name:    Age:

Address:   City:   

State:   Zip:


Parent's Name:

Home Phone:   Cell Phone:

# of Extra Tickets needed (NOT including participant):   

T-shirt Request:

Please check the t-shirt size(s) you would like to reserve. Participant shirt cost is included in the registration fee. Additional shirts may be purchased for $10.00 each.

Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large

Camp and Clinic Release of Liability Form

I am aware that participating in dance can be a dangerous activity involving MANY RISKS OF INJURY. I understand that the dangers and risk of participating in dance include, but are not limited to, death, serious neck and spinal injuries and serious injury or impairment to other aspects of my body, general health or well being. Because of the dangers of participating in dance, I recognize the importance of following the coach's instruction regarding playing techniques, training and team rules, and to obey such instructions. In consideration of Coastal Carolina University permitting me to participate in the Coastal Carolina University dance clinic and to engage in all activities related to the cheerleading clinic. I hereby voluntarily assume all risks associated with participation and agree to exonerate and save harmless Coastal Carolina University, their agents, servants, and employees from any and all liability claims, causes of action or demands of any kind and nature whatsoever which may arise by or in connection with my participation in any activities related to Coastal Carolina Dance Clinic.

I have carefully reviewed and voluntarily agree to the terms of this waiver and release of liability agreement.

Print Participant's Name:

Parent/Guardian Name Date:

All Fields are Required Verify characters:



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