Tiny Dancers, Dance With Me!

Tiny Dancers, Dance With Me

We are so glad you're here!
Date: Wednesdays, June 10th, 17th & 24th
Time: 9:00-9:45am
Location: The Studio - 120 Williams Industrial Dr. Pittsfield IL 62363
Dancer Information

If you are registering 2 dancers from the same family, you may enter both of their information on one form
Dancer Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Gender
Medical Information
Please let us know if you have any allergies, existing illnesses or any medical conditions.
Are you currently taking any medication that we need to know of that could interfere with camp activities? If yes, please explain below.

Payment Details
Session fee: $40 for all 3 classes (paid for at time of registration) or $15 drop in fee (paid for at time of class)

After you press "submit" you will be directed to the payment page.
My Products
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Tiny Dancer, Dance With Me - 3 classes$40.00
1 Dancer

Total $0.00
Acknowledgment, Authorization, and Waiver
This camper has my authorization to engage in the activities of the The Studio Summer Camp program.

I allow taking photography of this camper that can be used for The Studio portfolio or advertising.

I authorized The Studio to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if they are unable to contact the parent/guardian. I allow them to apply first aid, medical or surgical diagnosis and treatment as necessary.

I allow The Studio to provide or administer the medication or supervise in self-administration.

I release The Studio and any of its coaches, staff, and manager for any responsibility in case of accident, illness, or injury during this camper's enrollment.
Date Signed

MonthDayYear
Date
Parent/Guardian Signature
The Studio
120 Williams Industrial Dr, Pittsfield IL 62363
217-691-5707

www.thestudiopittsfield.com
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Tiny Dancers, Dance With Me