2026 LilyRoze Spotlight Summer Camp Application

2026 Spotlight Summer Camp Form

Welcome to Spotlight Summer Camp at LilyRoze Studios!
Child's Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Age *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender*
T-Shirt Size*
Mother's Name

First NameLast Name
Mother's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mother's Email
example@example.com
Father's Name

First NameLast Name
Father's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Father's Email
example@example.com
Emergency Contact *

First NameLast Name
Emergency Contact's Phone Number *
Please enter a valid phone number.Format: (000) 000-0000.
YesNoOther
Specify any of your child's health problems:
YesNo
Full-timePart-time Note: Must attend a minimum of 4 weeks (weeks do not have to be consecutive).
If so, please specify:

Parent Statement
Acknowledgment of Risk and Release of Liability:
I, the undersigned, hereby affirm that the above-named camper is in good mental and physical health and capable of participating in activities provided by LilyRoze Inc., including but not limited to cheerleading, tumbling, dance training, baseball, basketball, soccer, and related competitions.
I acknowledge that activities involving motion, height, or athletic endeavors carry inherent risks, including the potential for serious injury.
I, on behalf of myself and the above-named camper, voluntarily assume all risks associated with participation in these activities.
I hereby release and hold harmless LilyRoze Inc., its employees, staff, agents, and assigns from any and all liability, claims, demands, or causes of action arising out of or related to any loss, damage, or injury, including death, that may be sustained by the camper, or to any property belonging to the camper, while participating in camp activities or traveling to and from such activities.
Medical Consent:
In the event of a medical emergency, I authorize LilyRoze Inc. and its representatives to seek and obtain necessary medical treatment for the camper.
I understand that I will be responsible for any medical expenses incurred.
Code of Conduct:
I acknowledge that LilyRoze Inc. reserves the right to deny admission or dismiss any participant who does not meet the program's standards or engages in inappropriate conduct, including but not limited to disruptive behavior.
I agree not to hold LilyRoze Inc. or its representatives responsible in the event that the camper engages in such conduct, whether on or off camp premises, and understand that dismissal from the program may result without refund.
Accuracy of Information:
I attest that all information provided in this application is accurate and complete to the best of my knowledge.
I have read, understand, and agree to comply with the policies and fee statements of LilyRoze Inc.

Parent Signature Signature Date Date
You have our permission, in the event of an emergency and in case we are unavailable, to authorize any physician, nurse practitioner or medical personnel to examine, interview, test and if necessary, treat my childchild's name   as they may deem advisable.

Parent/Legal guardian
name   First Name   Last Name   Date   Date

Student Allergies   Type Here

Student Medical Problems Type Here

DoctorDoctor's Name   Phone numberArea Code   Phone Number

Insurance carrierType a label   Policy numberType a label
I hereby give permission to LilyRoze Inc., to photograph and/or videotape the student for educational or promotional purposes. Inital

Registration
Input $Dollar amount below:

prevnext( X )
USDDescription
Spotlight Summer Camp Registration Fee: $50Early Bird Registration Fe: $25

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

2026 Spotlight Summer Camp Form

Parent Statement

Registration