Summer Camp 2024 Registration Form
Please fill in the form below.
Today's Date
*
/
Month
/
Day
Year
Date
New or Returning Student
New Student
Returning Student
Contact and billing information:
Parent #1 Name
*
First Name
Last Name
Parent #1 Number
*
Parent #2 Name
First Name
Last Name
Parent #2 Number
Primary E-mail
*
Email is our #1 form of communication!!
Secondary E-mail
Email is our #1 form of communication, please include if you'd like a second email address to receive notices.
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
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California
Colorado
Connecticut
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District of Columbia
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Georgia
Hawaii
Idaho
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Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Students Full Name
*
First Name
Last Name
Students' Birthday
*
/
Month
/
Day
Year
Date
Allergies or Medical Conditions we should be aware of
*
Age
*
Years of Dance Training
*
Where have you trained?
How did you hear about bellA dance?
Camp Selection
"Come on Barbie, let's have a dance party" - July 8, 2024 - July 12, 2024
"In my bellA dance ERA" - July 22, 2024 - July 26, 2024
"Candy Land"- August 5, 2024 - August 9, 2024
Do you have additional students to register? (note: if registering more than 2 siblings please email belladancedesk.com for help)
*
Yes
No
Additional Students Full Name
*
First Name
Last Name
Additional Students' Birthday
*
/
Month
/
Day
Year
Date
Age
*
Allergies or Medical Conditions we should be aware of
*
Years of Dance Training
*
Where have you trained?
Camp Selection
"Come on Barbie, let's have a dance party" - July 8, 2024 - July 12, 2024
"In my bellA dance ERA" - July 22, 2024 - July 26, 2024
"Candy Land"- August 5, 2024 - August 9, 2024
Total number of combined camps
Printed Name
*
Signature
*
Payment 50% of camp price is due at time of registration (Note: by registering for camp, we are removing a space for a student to sign up, thus this is a NON REFUNDABLE deposit. The balance is due on or before the first day of camp).
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next
( X )
1 Camp ($180 total/$90 deposit)
$
90.00
2 Camps ($324 total/$162 deposit)
$
162.00
3 Camps ($486 total/$243 deposit)
$
243.00
4 camps ($648 total/$324 deposit)
$
324.00
5 camps ($810 total/$405 deposit)
$
405.00
6 camps ($972 total/$486 deposit)
$
486.00
Total
$
0.00
Credit Card
Returning students ONLY- by checking the box the card on file from 2022-23 dance season will be charged for your camp BALANCE the first day of dance camp.
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