DYNAMIC DANCE STUDIO WEWOKA
Summer Dance Camp 2025
June 9th - August 1st (Monday-Friday)
Student Info
Student Name
First Name
Last Name
Age
Birthdate
-
Month
-
Day
Year
Date
Please advise of any medical concerns and/or allergies
Parent/Guardian Info
Parent Name (1)
First Name
Last Name
Parent Name (2)
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Emergency Contact Info
Emergency Contact Name
First Name
Last Name
Emergency Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact (2)
First Name
Last Name
Emergency Contact Phone Number (2)
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized People to Pick Up Your Child
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
How will your child get home after class?
Picked up by Parent/Guardian
Walk/Drive home
DDS Transportation (Extra FEE charged)
Dynamic Dance Studio Photo/Video Release
I acknowledge and consent to allow Dynamic Dance Studio Wewoka to use photos and/ or videos of my child in publications such as flyers and brochures, advertisements such as new papers or online ads, our studio's website, or on social media such as the studios' Facebook and Instagram account. To ensure privacy, specific names of children will not be included. Dynamic Dance Studio reserves the right to discontinue use of photos or videos at anytime without notice. I further understand no financial compensation will be paid for the use of these photos/videos.
*
Yes
No
Photo/Video Release Signature
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Cash App Payment
In Person Cash Payment
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