Legacy in Motion Summer Camp Registration Form

Legacy in Motion Summer Camp

At Legacy in Motion LLC, our summer camp goes beyond physical fitness by offering an enriching experience that promotes personal growth, confidence, and life skills. The camp is designed for children ages 6-17 and focuses on step dancing, physical conditioning, and fun group activities. In addition to our core focus on step, each session will include tailored workshops aimed at building self-esteem, fostering leadership skills, and teaching valuable life lessons, such as teamwork, communication, and resilience. Our experienced coaches work to ensure each participant grows not only as a dancer but also as an individual, developing confidence, emotional intelligence, and practical life skills that they can carry forward. With two distinct sessions, our program provides a dynamic, well-rounded experience designed to inspire and empower all participants.
Child's Name

First NameLast Name
Child's Birthday

MonthDayYear
Grade:
School:
Child SmallChild MediumChild LargeChild XLAdult SmallAdult MediumAdult LargeAdult XL
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Address

Street Address

Street Address Line 2

CityState / Province

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Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does your child have any allergies, chronic illness, medical conditions or current medications? If yes, please describe.
Is your child prescribed an inhaler? If yes, please explain any instructions.
INFORMED CONSENT AND ACKNOWLEDGMENT

I, the undersigned parent/guardian, acknowledge and understand the following:

I voluntarily consent to my child’s participation in Legacy in Motion LLC Summer Camp and related physical activities, which include but are not limited to step instruction, physical conditioning, group drills, and interactive games.

I understand the camp is designed to promote discipline, teamwork, coordination, physical fitness, and self-confidence through structured movement-based activities.

I understand that Legacy in Motion LLC staff will provide supervision and instruction to the best of their ability, but cannot guarantee the elimination of all risks.

I agree to communicate any concerns, behavioral issues, or special needs regarding my child prior to the start of the session.

I acknowledge that I have received, read, and agree to all policies, including but not limited to attendance, payment, drop-off/pick-up procedures, emergency response, and media consent.

I understand that Legacy in Motion LLC reserves the right to dismiss any child whose behavior is consistently disruptive or unsafe, without a refund.

By signing below, I confirm that I have been informed of the nature of this program, and I give my full consent for my child to participate.
MEDICAL EMERGENCY CONSENT
In the event of a medical emergency, I authorize Legacy in Motion LLC staff to obtain medical treatment for my child at my expense, including transportation by emergency vehicle if deemed necessary. I understand that every reasonable effort will be made to contact me before such action is taken. I agree to be financially responsible for any expenses incurred as a result of such treatment.
RELEASE OF LIABILITY
I, the undersigned parent or legal guardian of the above-named participant, understand and acknowledge that participation in Legacy in Motion LLC activities, including but not limited to step training, conditioning, and group games, involves physical exertion that carries the risk of injury.

In consideration for being allowed to participate, I hereby release, waive, discharge, and covenant not to sue Legacy in Motion LLC, its owners, employees, contractors, agents, volunteers, or affiliates from any and all liability, claims, demands, or causes of action arising out of or relating to any loss, damage, or injury, including death, that may be sustained by the participant or to any property belonging to the participant while participating in or traveling to and from camp activities.
ASSUMPTION OF RISK
I understand and acknowledge that participation in this program includes inherent risks such as slips, falls, sprains, dehydration, and other injuries associated with physical activity. By signing below, I voluntarily assume all risks associated with my child's participation, both known and unknown, and accept full responsibility for any resulting consequences.
PAYMENT INFORMATION & POLICY
I understand that full payment is due prior to the start of my camp. The full payment of $250 will be due no later than June 15th, 2026. No refunds will be given for missed days unless Legacy in Motion LLC cancels the program.

Camp will take place July 6th - July 23rd, Monday-Thursday.

Registration & Fees
Registration Opens: February 1st

Registration Fee: $35

Camp Fee: $250

Payment Plans Available (all balances due by June 15th)
Payment Plan Options
Weekly: $62.50 every Friday
Bi-Weekly: $125
Monthly: $62.50 on the 15th of each month
Pay in Full: On the 15th of the month of your choice
I grant permission for Legacy in Motion LLC to use photographs or video recordings of my child for promotional or educational purposes (e.g., website, flyers, social media)I DO NOT grant permission for the use of photos or video recordings of my child.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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