Summer Intensive Registration Form

En Pointe Dance & Fitness Summer Intensive Registration Form

Once we receive your dancers registration, your will receive a personal email with payment options. Summer intensive cost: $375 9+Yrs, $200 5-8Yrs
Dancer Information
Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade entering in Fall
Number of Years Dancing*
Styles trained in*
Week(s) of Dance Intensive*

July 8, 2024 through July 12, 2023 Age 9-12yrJuly 29, 2024 through August 2, 2024 Age 12-18yrJuly 29, 2024 through August 2, 2024 Age 5-8yrAugust 12, 2024 - August 16, 2024 Age 9-12yrAugust 12, 2024 - August 16, 2024 Age 5-8yr
Parent/Guardian Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship
Phone Number*
Alt. Phone Number
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is your child prescribed an inhaler or epi-pen? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by En Pointe Dance & Fitness, LLC during the selected dance intensive. In exchange for the acceptance of said child’s candidacy by En Pointe Dance & Fitness, LLC , I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless En Pointe Dance & Fitness, LLC. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against En Pointe Dance & Fitness, LLC . including all teachers, councelers and affiliates, all participants, and, if applicable, owners and lessors of premises used to conduct the event.
Medical Release and Authorization

As Parent and/or Guardian of the above named child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention.

Permission is also granted to the En Pointe Dance & Fitness, LLC. and its affiliates including teachers, counselers and and staff for minor injury treatment, or emergeny medical treatment prior to the child’s admission to the medical facility if deemed necessay.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
I underdstand that a non-refundable camp deposit of $100 is required to secure my child's space in camp. Full camp payment of $375 ($325 if registered prior to 5/1/24) must be made 30 days prior to the start of camp.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*

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En Pointe Dance & Fitness Summer Intensive Registration Form

Dancer Information