Summer Dance Camp Registration

Summer Dance Camp Registration

Student 1

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Student 2 (if applicable)

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Student 3 (if applicable)

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Student 4 (if applicable)

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Name of Parent/Guardian 1
Name of Parent/Guardian 2
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Cell Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Health Information and Medical Emergencies
Allergies/Special Health Considerations
Emergency Contact #1
Relationship to Student
Phone Number

Area CodePhone Number
Emergency Contact #2
Relationship to Student
Phone Number

Area CodePhone Number
Waiver and Release From Liability For Dance Instruction
I, * (PRINT YOUR NAME) have chosen to have my child(s), * (PRINT YOUR CHILD(S) NAME), participate in dance instruction given by Grace and Glory Dance Academy. I acknowledge that I understand the nature of the activities my child will be participating in. In consideration of my child's enrollment in dance instruction, I understand and agree on behalf of myself and my child, to release, hold harmless, and discharge Grace and Glory Dance Academy from all claims, costs, liabilities, expenses or judgments, including attorneys' fees and court costs for any occurrences in connection with any dance instruction. I assume all risks to my child in connection with any dance instruction and further release Grace and Glory Dance Academy and the Rosburg Hall from liability for any injury or sickness sustained by my child while he or she is enrolled in dance instruction, including all risks reasonably connected with such activity whether foreseen or unforeseen.

I understand that Grace and Glory Dance Academy is not responsible for my child or other children who are left unsupervised outside of the areas surrounding the dance studio and that Shellie will only be supervising my child when he or she is participating in scheduled dance instruction.

I understand that Grace and Glory Dance Academy or the Rosburg Hall is not responsible for personal property that is lost, damaged or stolen while I or my child is on the Rosburg Hall's property.

I authorize and agree that Grace and Glory Dance Academy may take and use photographs, videos or likenesses of myself or my child for sharing or advertising for Grace and Glory Dance Academy.

My signature is proof of my intention to execute a complete and unconditional waiver and release of all liability pursuant to the terms herein, and agreement as to all terms and conditions contained above. I am of lawful age and competent to sign this affirmation.
Name

First NameLast Name
Signature
Date

MonthDayYear
Date
Dance Camp Fee

.
Thank you for registering your child(s) for summer dance camp! I am SO excited to see them and have lots of fun dancing!

Classes will be a combination of ballet and hip hop. Your dancer will need to wear sneakers/tennis shoes and athletic clothes. If they have ballet slippers, they can bring those. If not, barefoot or socks will also work. If you have any questions beforehand, don't hesitate to reach out to me through email: graceandglorydance@gmail.com. Can't wait!!

Love,

Shellie

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Age 5 - High School Camp Fee$50.00

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Age 4 Camp Fee $30.00

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Total $0.00

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Summer Dance Camp Registration

Health Information and Medical Emergencies

Waiver and Release From Liability For Dance Instruction

Dance Camp Fee

My Products

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