2025 DX Youth Summer Camp Registration

Summer Camp at Dance Exchange

Dance Exchange will host 3 weeks of summer dance camps, with 3 separate and exciting dance styles and explorations of a wide range of dance forms including contemporary, improvisation, hip hop and creative movement. Students will explore diverse dance forms, develop dance making skills, and cultivate leadership abilities. Each week concludes with a performance, allowing campers to share their learning and creations with family and friends.
For which Summer Camp session are you registering?*

July 7-11, 2025: Hip Hop Experience Dance Camp with iDanceJuly 14-18, 2025: Contemporary Dance Camp with Shannon Quinn
Guardian Information
Guardian Name*

First NameLast Name
Guardian Phone Number*
Guardian Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about our program?
Dance Exchange Mailing List

Yes, subscribe me to the Dance Exchange mailing list. (You can unsubscribe at any time).
Student Information
Student Name*

First NameLast Name
Student Birth Date*

MonthDayYear
Student Pronouns
To learn more pronouns visit: https://pronouns.org/
What school does your student attend?
What are your student's accessibility needs?
For more information visit: https://www.cdc.gov/ncbddd/disabilityandhealth/disability-barriers.html
Has your student attended any Dance Exchange programming before? If so, please describe below:
Has your student had any prior dance experience? Prior experience is not necessary for participation in any of Dance Exchange's summer camps.
Emergency Contact Information
Emergency Contact *

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Pick Up Contact Information

Please share the names and phone numbers of the people who are approved to pick up your student from Dance Exchange (other than the guardian listed above).
Pick Up Person #1

First NameLast Name
Relationship to student

Parent/Legal GuardianFamily Member or Extended Family MemberFriendOther
Pick Up Person #1 Phone
Please enter a valid phone number.
Pick Up Person #2

First NameLast Name
Relationship to student

Parent/Legal GuardianFamily Member or Extended Family MemberFriendOther
Pick Up Person #2 Phone
Please enter a valid phone number.
Please add any additional approved pick up people here or share any additional information we should know about pick up plans.
Health and Medical Information
Please describe all of your child's known food allergies:
Please describe all of your child's known allergies to medications:
Scholarship

Two half-price scholarships are available. Your family would still be responsible for a $250 payment. Scholarships will be awarded based on need as well as excitement about / interest in the program. Limited availability.
Are you applying for a scholarship for your student?

YesNo
Please give us a sense of your family's financial need.
A question for your student: Why are you excited about dance, creativity, and performance?
Liability and Media Release
LIABILITY RELEASE: Before registering, please read the following disclaimer. By clicking yes, you are agreeing to the following: I, acknowledge that I have voluntarily enrolled myself and/or my child in this program and assume responsibility for all risks of injuries resulting from our participation in activities with Dance Exchange. I certify that myself and my child are physically and mentally capable of participating in these activities. I hereby represent that I have informed Dance Exchange of any pertinent medical conditions that may affect participation in these activities, including but not limited to classes, rehearsals, performances, or related events. I voluntarily agree to release, discharge, and hold harmless Dance Exchange for any and all claims of liability which causes injury, whether based on allegations or not, in any way. Should emergency medical services become necessary for the undersigned participant, the expenses are the sole responsibility of myself and not that of Dance Exchange. I understand that this is the entire agreement between myself and Dance Exchange, its owners, officers, board, agents, and employees and that it cannot be modified or changed in any way by the representatives or statements by Dance Exchange or by myself.*

I agree
MEDIA RELEASE: I, hereby grant to Dance Exchange the irrevocable and unrestricted right to use and publish, alter, and copyright quoted material, photographs or video images of myself and/or my child, audio recordings, text/writings/drawings my child or I produce for Dance Exchange publications, electronic reproductions (website) and/or any other purpose and in any manner or medium an unlimited number of times in perpetuity for any lawful purpose. I hereby release the photographer/videographer/documenter and the Dance Exchange from all claims and liability relating to said photographs/video/audio/text. I understand that the Dance Exchange will exercise care in protecting the context of quoted material or image. I understand that I will not receive any monetary compensation for the permissions I am granting herein. I understand cannot withdraw this consent after I sign this form and that this consent and release is binding.*

I agree
Payment

Choose one *

Hip Hop Experience Dance Camp with iDanceJuly 7-11, 2025

$500.00

Contemporary Dance Camp with Shannon QuinnJuly 14-18, 2025

$500.00

Scholarship ApplicationIf you are applying for a scholarship, be sure the questions above are completed. Scholarships will be awarded on a rolling basis. If you are awarded a partial scholarship, we will invoice you separately. If you do not receive a scholarship, we will invoice you separately if you still plan to send your student.

$ Free

Total

$0.00

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

Should be Empty:

Summer Camp at Dance Exchange

Guardian Information

Student Information

Emergency Contact Information

Pick Up Contact Information

Health and Medical Information

Scholarship

Liability and Media Release

Payment