Dance Camp Registration’s Form

Summer Dance Camp Registration
Join us for summer dance camp July 13th - 17th
- Ages 5-10, camp will be held from 9-12
- Ages 11-18, camp will be held from 1-4
Dancers Information
Dancer's Name

First NameLast Name
Birth Date

MonthDayYear
Age
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name

First NameLast Name
Home Number

Area CodePhone Number
Cell Number

Area CodePhone Number
E-mail
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Does the dancer have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the dancer prescribed an inhaler? If yes, please explain any instructions.
Dancer’s Shirt size

USDRegistration Fee

Summer Dance Camp Registration