Day Camp Registration form

We’re so excited to dance with you! We appreciate you sharing this information with us and honor your privacy. Your information will be kept confidential and will not be released without your consent.

Student's Name

First Name

Last Name

Student's Date of Birth

YYYY

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian

(if 18 years of age or older, write N/A)

First Name

Last Name

Email Address

Phone #

(###)

###

####

Emergency Contact #1

First Name

Last Name

Phone

(###)

###

####

Emergency Contact #2

First Name

Last Name

Phone

(###)

###

####

Please list any current medications.

Please list any medication allergies.

Please list any food allergies.

Please list any other allergies.

Please list any chronic health concerns.

Please inform us of any other vital information you think we may need to know in the event of an emergency.

Level Selection

Select all that apply

Intermediate (ages 7-14)

Advanced (ages 11-18)

I will pay with:

Cash

Credit Card

Check

Day Camp Registration form

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