Clone of 2026 LilyRoze Spotlight Summer Camp Application

2026 Spotlight Summer Camp Form

Welcome to Spotlight Summer Camp at LilyRoze Studios!
Child's Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Age *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender*
T-Shirt Size*
Mother's Name

First NameLast Name
Mother's Phone Number
Please enter a valid phone number.
Mother's Email
example@example.com
Father's Name

First NameLast Name
Father's Phone Number
Please enter a valid phone number.
Father's Email
example@example.com
Emergency Contact *

First NameLast Name
Emergency Contact's Phone Number *
Please enter a valid phone number.
I'd like to enroll in extended care! (7am-6pm) Additional $10 per week

YesNoOther
Specify any of your child's health problems:
Is your child on any medication?

YesNo
Enrollment Status*

Full-timePart-time Note: Must attend a minimum of 4 weeks (weeks do not have to be consecutive).
If so, please specify:

Camp Information
Camp Dates:
Session: June 2nd – July 25th
Our camp will be held at Limit Breaker Church, located at 6720 E Raines Rd, Memphis, TN 38115.

Lunches & Snacks: 1 Lunch and 1 Snack Provided. If you will be sending your child’s lunch, please be sure that your child’s lunch is clearly marked with your child’s name and last name. Refrigerators will not be available for your child to store his/her lunch. Glass bottles/containers are not allowed.

Payments: Tuition may be paid through Cash App, Credit/Card or PayPal

Camp Fees:
Standard Weekly Rate: $95 per week
Full-Time Enrollment Discount:
- Eligibility: Enroll for all 8 weeks and commit to bi-weekly payments.
- Discounted Rate: $85 per week
- Total Cost for 8 Weeks: $680
- Payment Schedule: Up to 4 installments
Extended Care:
- Optional: $10 per week
Minimum Enrollment: Students must register for at least 4 weeks.
Payment Options:
Weekly Payments: $95 per week
Bi-Weekly Payments for Full-Time Enrollment:
- Amount: $170 every two weeks ($85 per week)
- Number of Payments: Up to 4 installments
Additional Information:
Discount Eligibility: The discounted rate of $85 per week is exclusively for students enrolled full-time (all 8 weeks) with a bi-weekly payment plan.
Extended Care: Available at an additional $10 per week; please indicate your interest during registration.
Registration Requirement: A minimum commitment of 4 weeks is required for all students.

-DROP OFF AND PICK UP TIMES
Drop off time: 8:30AM
Early Drop off: 7:00AM Additional $10 per week
Pick up time: 5:30PM
Extended Pick-up: 6:00PM (included in extended care)
A $1 fee will be charged for every minute late after a 10-minute courtesy wait.

Contact Information

For more information:
Nadia Childres
Camp Director
Phone Number: 901-602-1686
Email: info@lilyrozestudios.com

Parent Statement
Acknowledgment of Risk and Release of Liability:
I, the undersigned, hereby affirm that the above-named camper is in good mental and physical health and capable of participating in activities provided by LilyRoze Inc., including but not limited to cheerleading, tumbling, dance training, baseball, basketball, soccer, and related competitions.
I acknowledge that activities involving motion, height, or athletic endeavors carry inherent risks, including the potential for serious injury.
I, on behalf of myself and the above-named camper, voluntarily assume all risks associated with participation in these activities.
I hereby release and hold harmless LilyRoze Inc., its employees, staff, agents, and assigns from any and all liability, claims, demands, or causes of action arising out of or related to any loss, damage, or injury, including death, that may be sustained by the camper, or to any property belonging to the camper, while participating in camp activities or traveling to and from such activities.
Medical Consent:
In the event of a medical emergency, I authorize LilyRoze Inc. and its representatives to seek and obtain necessary medical treatment for the camper.
I understand that I will be responsible for any medical expenses incurred.
Code of Conduct:
I acknowledge that LilyRoze Inc. reserves the right to deny admission or dismiss any participant who does not meet the program's standards or engages in inappropriate conduct, including but not limited to disruptive behavior.
I agree not to hold LilyRoze Inc. or its representatives responsible in the event that the camper engages in such conduct, whether on or off camp premises, and understand that dismissal from the program may result without refund.
Accuracy of Information:
I attest that all information provided in this application is accurate and complete to the best of my knowledge.
I have read, understand, and agree to comply with the policies and fee statements of LilyRoze Inc.

Parent Signature Signature Date Date
You have our permission, in the event of an emergency and in case we are unavailable, to authorize any physician, nurse practitioner or medical personnel to examine, interview, test and if necessary, treat my childchild's name   as they may deem advisable.

Parent/Legal guardian
name   First Name   Last Name   Date   Date

Student Allergies   Type Here

Student Medical Problems Type Here

DoctorDoctor's Name   Phone numberArea Code   Phone Number

Insurance carrierType a label   Policy numberType a label
I hereby give permission to LilyRoze Inc., to photograph and/or videotape the student for educational or promotional purposes. Inital

Registration
If you plan to pay via Debit, Credit, or PayPal, you can skip this section.For other payment options: Select your choice from the dropdown below and click the Submit button at the bottom of this application. An invoice will be sent to you once we receive your completed application.
Input $Dollar amount below:

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To ensure accurate processing of your payments via Cash App or Zelle, please include your child's full name in the 'For' or 'Memo' section of the transaction. This allows us to match your payment with your child's application efficiently.

Spotlight Summer Camp Registration Fee: $50

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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2026 Spotlight Summer Camp Form

Camp Information

Contact Information

Parent Statement

Registration