Day Camp Registration Form

Camps span two and a half hours each day and encompass various activities, such as dancing, craft sessions, and snack time. Participants are encouraged to bring their own snacks for the camp, while craft materials and tons of fun will be supplied. Secure your spot today!
Fill out this secure form to register for Northern Plains Dance's Day Camps. You may only register one student per form.
Student Name*

First NameLast Name
Age*
Birthdate*

MonthDayYear
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Other Phone

Area CodePhone Number
E-mail*
Camp sizes are limited. Payment is required in order to reserve your spot. Payments are non-refundable. Child must meet the minimum age by the first day of camp in order to be eligible.
By checking this box, I am confirming that my child is fully potty trained according to the following guidelines:

A full potty trained child can:

-Communicate to the teachers that he/she needs to go to the restroom before they need to go.
-Alert him/herself to stop what he/she is doing, to go and use the bathroom.
-Pull down his/her clothes and get them back up without assistance.
-Wipe him/herself after using the toilet.
-Get on/off the toilet by him/herself.
-Wash and dry hands.
-Postpone going if they must wait for someone who is in the bathroom.
Yes, my child is potty trained

Select your age group to view camps.*

Ages 4-6$39.00

All camps run from 9:30am-12:00pm

Select your Camp	Quantity
Butterflies and Fairies Day Camp \| April 4

Item subtotal:$0.00

Ages 6-8$39.00

All camps run from 9:30am-12:00pm

Select your Camp	Quantity
Butterflies and Fairies Camp \| April 4

Item subtotal:$0.00

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Total $0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

LIABILITY RELEASE: I hereby release Northern Plains Dance or Ballet (NPD) and its agents and employees from all liability for personal injury, illness or property damage occurring on or off premises used, rented, leased, or owned by NPD. I certify that I am in good health and capable of participation in all activities and classes.

MEDICAL RELEASE: In an emergency, I authorize NPD, its employees and agents, in the event that I cannot be reached by telephone at the number(s) listed above, to transport and admit my child or myself to a local hospital for the purpose of emergency medical treatment. I release NPD, its employees and agents, from any liability incurred for the transportation and admission of myself or my child to a local hospital for emergency treatment.

PHOTOGRAPHY RELEASE: I hereby give permission to NPD to take photographs and/or videos of me or my child that will become permanently property of NPD. I consent to the use of such materials for promotional purposes by NPD.

MISCONDUCT POLICY: Participants and families understand that the NPD facilities and staff are to be treated with respect. Cases of misconduct will be addressed with the parent/guardian of the participant. NPD requires mutual respect between our students and instructors, as well as between our students and each other. Courtesy and good manners are expected and encouraged. In a case where a student displays continued misconduct, the student will, at the discretion of the teacher, be removed from the remainder of the camp with no refund.
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