VEDCSUMMER2K23

VEDC and ISPAC Summer Intensive Dance Camp Student Registration Form

Fill out the form carefully for registration
Dancer Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian E-mail
example@example.com
Mobile Number
Phone Number
Work Number
Company
Dance Camp Levels
Dancers are matched in levels during the first week of camp.
Indicate with any of your child's existing medical conditions:

seizuresvision impairedasthma/breathingheart conditionmy child wears glasses or contact lensesincontinent issues
Please list any previous medical injuries such as broken limbs or dislocations:
Food Allergies
Emergency Contact: (Who is authorized to pick up your child)
Physician's Name and Number and Hospital Preference
I hereby give my consent for Vertical Essence personnel to have and use the above information about my child to help him/her in case of an emergency. If I cannot be reached, I also authorize Vertical Essence to call the physician listed above and proceed with emergency treatment. I realize it is my responsibility to notify the company whenever there is a change.*

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Throughout Camp Student will be photographed, videotaped and interviewed. Pictures, Video and Interviews may be used as promotional tools for the website and or social media platforms.

I will allow my child to participateI will not allow my child to participate
Are there dates we can expect your dancer to not be in attendance? Please indicate below:
Our mission is to discipline and strengthen the minds and bodies of the children. Many activities include running (indoor and outdoor), push ups, help cleaning, time out or a research assignment

My child may participateMy child may not participate

VEDC and ISPAC Intensive Summer Dance Camp*

USDIntensive Camp Deposit

Payment Methods

Credit Card

Apple Pay

Google Pay

Signature

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VEDC and ISPAC Summer Intensive Dance Camp Student Registration Form

Payment Methods