Summer Camp/ Training Program Registration Form
Student Information
Name
First Name
Last Name
Age
*
Gender
Male
Female
2024 CLASS SCHEDULE
May 15th
5:30PM- 7:30PM
May 22nd
5:30PM-7:30PM
May 29th
5:30PM-7:30PM
June 5th
5:30PM-7:30PM
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Write something about yourself
Parent/Guardian Information
For minors (below 18 years of age)
Parent/Guardian Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Relationship
Shirt Size
S
M
L
XL
XXL
Payment & Confirmation
Payment Method
Cash
Check
Cash App ( $Dsimonestudioofdance)
Signature of Student
Date Signed
-
Month
-
Day
Year
Date
Parent/guardian Name
First Name
Last Name
Parent/guardian Signature
Date Signed
-
Month
-
Day
Year
Date
Print Form
Submit
Should be Empty:
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