SCS Summer Dance Camp

Summer Dance Camp

The Dance Academy at St. Catherine's
Please complete the form, waiver, and release information. If you have more than one child registering for any of the camps, please fill out individual information for each child. Select the camp(s) you would like to enroll in. If you have more than one child registering for the same camp, please indicate that in the Quantity selection.

Contact: Karen Grantham, karengrantham@att.net

Family Information
Parent Name

First NameLast Name
Parent Mailing Address *

Street Address

Street Address Line 2

CityState

Zip Code
Parent Phone Number*
Parent Email Address*

Confirmation EmailEmail Address
Primary Language Spoken at Home*
Please Click on the Medical Release Information box below to continue.

Medical Release Information
Medical/Hospital Insurance Carrier*
If you do not currently have Medical Insurance, type "None" in the box.
Name of Policy Holder
Policy Number
Group Number
Emergency Medical Treatment Release: In the event of an emergency, by initialing below, I hereby give permission to transport my child(ren) to a hospital for emergency medical attention and grant permission for non-prescription medications to be given, if deemed appropriate. (Any prescription medication to be given must be accompanied by a physician’s prescription or a parent note which should be provided separately). I wish to be advised prior to any further treatment by the doctor and hospital. If you are unable to reach me, my spouse, or the other desginated guardian, contact the Backup Emergency Contact below.
Medical Release Approval (Please initial below to approve above medical release)*
Emergency Contact*
Phone Number*
Please Click on the Child #1 Information box below to continue.

Child #1 Information
Child #1 Name*

First NameLast Name
Gender*
Date of Birth*

MonthDayYear
Allergies, Medications (with dosage), or Other Special Medical Issues*
Type NONE in the box, if there are no special medical issues.
Media Release*

I consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.I do not consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.
If you are registering an additional child, please click on the Child #2 Information box below, otherwise please proceed to the very bottom of the form and click on the Payment Information/Authorization Box.

Child #2 Information
Child #2 Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Allergies, Medications (with dosage), or Other Special Medical Issues
Type NONE in the box, if there are no special medical issues.
Media Release

I consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.I do not consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.
If you are registering an additional child, please click on the Child #3 Information box below, otherwise please proceed to the very bottom of the form and click on the Payment Information/Authorization Box.

Child #3 Information
Child #3 Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Allergies, Medications (with dosage), or Other Special Medical Issues
Type NONE in the box, if there are no special medical issues.
Media Release

I consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.I do not consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.
If you are registering an additional child, please click on the Child #4 Information box below, otherwise please proceed to the very bottom of the form and click on the Payment Information/Authorization Box.

Child #4 Information
Child #4 Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Allergies, Medications (with dosage), or Other Special Medical Issues
Type NONE in the box, if there are no special medical issues.
Media Release

I consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.I do not consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.
If you are registering an additional child, please click on the Child #5 Information box below, otherwise please proceed to the very bottom of the form and click on the Payment Information/Authorization Box.

Child #5 Information
Child #5 Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Allergies, Medications (with dosage), or Other Special Medical Issues
Type NONE in the box, if there are no special medical issues.
Media Release

I consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.I do not consent to allowing my child’s image to be recorded, either by photograph or video, and used during the school year or for future print or digital advertisement of Parish events.

Dance Camp Descriptions
Cheer Camp Cost $120

Calling all girls who would love to cheer, dance, tumble, and have a great time!! This camp is designed with fun in mind. The camper will learn basic cheers, how to do stunts, work with pom-poms, basic tumbling skills, and dance line routines. No experience is needed – just bring your voice, great personality, and eagerness to learn. Girls will be given pom poms.

Space Camp Cost $120

Discover the vastness of space and our solar system! It will be a galaxy of fun as we explore movement through space, dance, create cosmic crafts, and others. Moonwalk over and get ready for a camp that is out of this world.
Please proceed to the to the COVID Release/Payment Information/Authorization Box.

COVID Release/Payment Information/Authorization
ASSUMPTION OF THE RISK RELATING TO COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person to person through respiratory droplets when an infected individual coughs, sneezes or speaks. As a result, government agencies at all levels and federal, state and local health agencies recommend social distancing and have placed limits on the congregation of groups of individuals.

St. Catherine of Siena Parish has put preventative measures in place to reduce the spread of COVID-19; however, the parish cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending activities on the campus of St. Catherine of Siena Parish could increase your risk and that of your children for contracting COVID-19.

While St. Catherine of Siena Parish will make all reasonable efforts to lower the risk of COVID-19 exposure and spread at the parish, the parish is unable to provide any guarantee that students or their families will not be exposed to or infected by COVID-19.

By enrolling your child(ren) in and attending parish faith formation, you acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that you, your child(ren) and or other family members may be exposed to or infected by COVID-19. It is expected that students and other family members will follow the preventative measures and guidelines implemented by St. Catherine of Siena Parish including not coming to the parish premises if demonstrating any signs or symptoms of COVID-19.

Dance Camp Fees

Week 4 (July 11-16)

Space Camp (July 11-16)$120.00

9:00am - 12:00pm Ages 3-5 and Ages 6-9

Quantity

Little Cheer Camp (July 11-16) $120.00

1:00pm - 4:00pm Ages 3-6

Quantity

Enter coupon

Total $0.00

Credit/Debit Card

*Transaction is made securely using Square Payments. Card information is not stored on St. Catherine's servers.

By signing below, I authorize payment if applicable and confirm the medical, media, and social media release information. I also confirm that I have read and accepted the COVID-19 release. Please note that you will not be able to submit this form until you have signed.
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