DDTB Camp Registration Form

Family Information
Parent 1/Guardian's Name*

First NameLast Name
Parent 2/Guardian's Name*

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

Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Relationship to Student*

Your Reason For Attending This Camp

Please describe what you or your child wish to gain from this experience
In 300 words or less, please describe your reasons for wishing to attend this camp.

0/300
Is your dancer interested in staying with us in the fall?

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Liability Waiver
The X-Perience Dance Company Camp Participation Waiver

I, the undersigned participant (or parent/guardian if the participant is under 18), acknowledge and agree to the following terms as a condition of participation in The X-Perience Dance Company camp:

Assumption of Risk – I understand that dance and physical activities involve inherent risks, including but not limited to falls, injuries, and physical exertion. I voluntarily assume all risks associated with participation.

Release of Liability – I hereby release, waive, and hold harmless The X-Perience Dance Company, its directors, instructors, staff, volunteers, and affiliates from any and all liability, claims, or demands arising from participation in the camp, including personal injury, property damage, or other loss, whether caused by negligence or otherwise.

Medical Treatment Authorization – In the event of an emergency, I authorize The X-Perience Dance Company staff to obtain medical treatment for the participant. I understand that I am responsible for any medical expenses incurred.
Code of Conduct – I acknowledge that participants are expected to follow all camp rules and guidelines. Failure to do so may result in removal from the program without refund.

Photo & Video Release – I grant permission for The X-Perience Dance Company to use photographs and videos of the participant for promotional, educational, or marketing purposes, unless I provide written notice opting out.
By signing below, I confirm that I have read, understand, and agree to the terms of this waiver.
Signature*

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Date*

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My Products

Camp Registration Fee

$60.00

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Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Methods

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Contact Info

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DDTB Camp Registration Form

Family Information

Emergency Contact Information

Additonal Questions

Your Reason For Attending This Camp

Liability Waiver