2025 Ticálié Summer Camp Registration Form

Dancers Information

Dancers Name*

First NameLast Name

Birthday

Date

Dancers Name

First NameLast Name

Birthday

Date

Dancers Name

First NameLast Name

Birthday

Date

Parent/Guardian Information

Name

First NameLast Name

Cell Number

Area CodePhone Number

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

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 or other medications we should know about? If yes, please explain any instructions.

The Ticálié Summer Camp is a 3-day camp that will be held on August 5, 6 & 7th. The Camp will start at 10 am and finish at 12 pm. Every day will be filled with Irish dance, games and crafts! Dancers will also receive a camp t-shirt to take home with them! Dancers should bring a water bottle, indoor running shoes or ballet shoes, and a small snack (peanut-free). We look forward to having your dancer attend the Ticálié Summer Camp.

My Products*

Summer Camp Deposit$25.00CAD

per dancer

Select to reflect number of dancers registered

Subtotal $0.00CADTax $0.00CADTotal $0.00CAD

Payment Methods

Credit Card

Apple Pay

Google Pay

Please note that the camp deposit is non-refundable. The only exception is if we have to cancel the camp due to unforeseen circumstances.

The remaining camp fee of $100 + tax is due before camp. A payment link will be sent to you email.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Ticálié Irish Dance Academy during the selected camp. In exchange for the acceptance of said child’s candidacy by Ticálié Irish dance Academy, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Ticálié Irish Dance Academy and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Ticálié Irish Dance Academy including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including dance. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Ticálié Irish Dance Academy and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

2025 Ticalie Summer Camp Registration

Payment Methods