LeadUS Mentoring Program 2015-16

Welcome to Industry Dance Co. We are so excited to have you join us for a summer full of fun. Please fill out and complete the registration form below, using the participant's information. Once complete, select "SUBMIT" and follow the link to finalize your child's day camp registration. We look forward to meeting you soon!

Parent/Guardian Information:
Full Name of Parent/Guardian

First Name Last Name
Mobile Number *

Area Code Phone Number
Mobile Number

Area Code Phone Number
E-mail *

Emergency Information:
Emergency Contact #1 *

First Name Last Name
Relation to Participant *
Phone Number *

Area Code Phone Number

Medical Information:
Does your child have any medical conditions/concerns that we should be aware of? (Asthma, epilepsy, diabetes, anxiety, ADHD, etc.) *

YES NO
If YES, please explain.
Does your child have any allergies we should be aware of? (Food, drug, seasonal etc.) *

YES NO
If YES, please explain.
Please list any other information you’d like to include about your camper:

Business Policies
All registration fees are non-refundable and are credited ONLY to Day Camps. Payments cannot be used to pay for other services such as merchandise, dance programs/classes, fitness programs/classes, etc. Should Industry Dance Co. have to temporarily close or adapt to new COVID-19 measures that would cause clients to not be able to attend class in person, all enrolled participants are subject to a full refund.

Yes, I agree / Understand
I, the parent or legal guardian of the applicant listed above, hereby give approval of the applicant’s participation in any and all of Industry Dance Co.’s programs and activities. I do waive, release, absolve, indemnify, and agree to hold harmless the organizers, sponsors, supervisors, participants, employees and independent contractors involved in the operation of Industry Dance Co.’s programs for any claims arising out of injury or other loss to named applicant or any member of his/her family whether as a participant in the activities or as a spectator. I authorize Industry Dance Co. to seek medical treatment at the nearest medical facility and they may call paramedics and discharge my child/ward to an ambulance if I am not able to authorize it in the case of a medical emergency. I certify that my child/ward is in good health and capable of participating in physical activities. I hereby give permission for Industry Dance Co. to take photos/videos of my child/ward for use on the website and for other promotional purposes. I understand that payment is non-refundable. Industry Dance Co. reserves the right to cancel the camp, with a full refund, should fewer than ten participants register.

Yes, I agree / Understand
Signature

Clear
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform