Acro Summer Clinics

Acro Summer Clinics

We're so happy you're here!
Date: Beginner/Intermediate Acro - July 6th & 13th - 5:00-6:00pm

Back handspring clinic - July 7th & 14th - 5:00-6:30pm

Location: The Studio - 120 Williams Industrial Dr. Pittsfield IL 62363
Camper Information
Camper Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Gender
Grade/Level
Medical Information
Please let us know if you have any allergies, existing illnesses or any medical conditions.
Are you currently taking any medication that we need to know of that could interfere with camp activities? If yes, please explain below.

Parent/Guardian Details
Parent/Guardian Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Details

If parent/guardian cannot be reached.
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number

Payment Details
Camp Fee:

Back Handspring Clinic - 1.5 hours

$30 for one clinic or $55 for both

Beginner/Intermediate Acro Clinic - 1 hour

$20 for 1 clinic or $35 for both

After you press "submit" you will be directed to the payment page.
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Back Handspring Clinic - 1 Dancer 1 Clinic$30.00
July 7th OR July 14th

Back Handspring Clinic - 1 Dancer 2 Clinics $55.00
July 7th AND 14th

Beginner/Intermediate Acro Clinic - 1 Dancer 1 Clinic$20.00
July 6th OR July 13th

Beginner/Intermediate Acro Clinic - 1 Dancer 2 Clinics$35.00
July 6th AND 13th

Total $0.00
Acknowledgment, Authorization, and Waiver
This camper has my authorization to engage in the activities of the The Studio Summer Camp program.

I allow taking photography of this camper that can be used for The Studio portfolio or advertising.

I authorized The Studio to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if they are unable to contact the parent/guardian. I allow them to apply first aid, medical or surgical diagnosis and treatment as necessary.

I allow The Studio to provide or administer the medication or supervise in self-administration.

I release The Studio and any of its coaches, staff, and manager for any responsibility in case of accident, illness, or injury during this camper's enrollment.
Date Signed

MonthDayYear
Date
Parent/Guardian Signature
The Studio
120 Williams Industrial Dr, Pittsfield IL 62363
217-691-5707

www.thestudiopittsfield.com
Should be Empty:

Acro Summer Clinics

Camper Information

Medical Information

Parent/Guardian Details

Emergency Contact Details

Payment Details

My Products

Acknowledgment, Authorization, and Waiver