CanDance Summer Camp Registration Form

CanDance Summer Camp Registration
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Age*
Child Name

First NameLast Name
Birth Date

MonthDayYear
Age
Child Name

First NameLast Name
Birth Date

MonthDayYear
Age
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
MEDICAL INFORMATION
Physician Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Does the child have any health restrictions ,and /or allergies? YES /NO (If yes please explain) Medical Concerns*
In Case Emergency (If Guardian Cannot Be Reached)*

First NameLast Name
Phone Number*

Area CodePhone Number

Child 1 Camp T-Shirt Size (Campers ONLY) *
Child 2 Camp T-Shirt Size(Campers ONLY)
Child 3 Camp T-Shirt Size(Campers ONLY)
Liability Release Form

I, the undersigned give permission to CanDance Summer Camp, CanDance Studio LLC, and Dream Center its directors, officers, employees and volunteers to seek medical treatment for my child in the event they are not able to reach a parent, guardian or any emergency contact. I also agree that I will be responsible for any financial incurred by said action. I have declared that my child to be in good and physical and mental health. I understand and agree, therefore, to assume all risks and responsibilities for any such injury or accident, which might occur to me or my child during any classes, rehearsals, performances or activities. I also exempt, release, and indemnify CanDance Summer Camp, CanDance Studio LLC, and Dream Center its owners, agents, volunteers, assistants, employees, contractors, guests, artists and/or students from liability claims, demands, or causes of action whatsoever from any damage loss, injury or death to me, my children, or property which may arise out of connection with participation in any classes, performances, rehearsals or activities conducted by CanDance Summer Camp, CanDance Studio LLC, and Dream Center. I further hereby voluntarily agree to waive my rights and that of my heirs assigns to hold CanDance Summer Camp, CanDance Studio LLC, and Dream Center its owners, agents, volunteers, assistants, employees, contractors, guests, artists and/or students liable for such damage, loss, injury or death. I understand that I am aware of my child physical limitations and agree to not exceed them. If I am signing this waiver for my child, I certify that I am the parent or legal guardian and have the right to sign these rights.

*I give CanDance Summer Camp & CanDance Studio LLC, permission to use photographs and video tapings of my child for publicity purposes only.
Signature*

Clear

My Products*

Per Camper$50.00

Quantity
Item subtotal:$0.00

Total $0.00

Credit Card

Should be Empty:

CanDance Summer Camp Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

MEDICAL INFORMATION

Credit Card