EHS Fall Dance Camp Registration Form

Eastlake Dance Team - 2024 FALL Dance Camp Registration Form

One Day Fall Dance Day Camp: Friday October 18th. There is NO SCHOOL for LWSD
Dancer Name

First NameLast Name
Dancer Birthdate

MonthDayYear
Grade & School Name in the fall
How did you hear about Camp?

Family Information
Parent/Guardian's Name

First NameLast Name
Parent/Guardian's Name

First NameLast Name
Contact Phone Number
E-mail Address
example@example.com
Primary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Relationship to Student

Child's Doctor Name & Phone Number
Child's Insurance Company & Policy Number
* List any Allergies and/or Medical or Physical Limitations we should be aware of:

EHS DANCE CAMP WAIVER

Please read and sign below
**This Dance Clinic is NOT sponsored by the Lake Washington School District.
I acknowledge that the minor and I fully understand that the minor’s participation may involve risk of serious injury or death, including economic losses, which may result not only from the minor’s own actions, inactions, or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the event or activity is being conducted, the rules of
play, or this type of event or activity; I assume any and all risks of personal injuries to the minor and authorize the Sponsor to contact or employ a licensed physician to render any medical treatment that may be deemed necessary for the
minor or to take and admit the minor to any hospital. If such medical treatment or hospitalization is required, I agree to pay all medical and hospital bills relating thereto, permanent or partial disability or death and damages to the minor’s or my property, caused by or arising from the minor’s participation in
the event or activity; I release, waive, discharge and relinquish the Lake Washington School District, the Eastlake Dance Boosters and their respective officers, volunteers, dancers, coaches and agents from any liability, loss,
damage, claim, demand or cause of action against them attributable to the minor’s participation in the event or activity, whether same shall arise by their negligence or otherwise.
Parent/Guardian full name
Parent/Guardian Signature

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My Products

EHS 2024 Fall Dance Camp

$65.00

LWSD Staff Fall Camp Fee

$50.00

Total

$0.00

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Eastlake Dance Team - 2024 FALL Dance Camp Registration Form

Family Information

Emergency Contact Information

EHS DANCE CAMP WAIVER

Credit Card