Summer Camp Detailed Registration Form

Dance Camp Registration
Student Information
Student's Name

First NameLast Name
Birth Date*

DayMonthYear
Age as of 1st January 2026*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
DAYS OF ATTENDANCE (tick all that apply)*

Wednesday 21stThursday 22ndFriday 23rd
Will the student attend the sleepover on the 22nd January?*

YesNo
Parent/Guardian Information
Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship
Phone Number*
Alt. Phone Number*
Does the student have any allergies and or medical conditions? If yes, please describe.*
Is the student required to take any medication? If yes, please explain any instructions.*
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Hume Dance School during the 2026 summer dance camp.

I am aware that full payment is required before the commencement of the dance camp.

I am aware that all food or drink given to my child to take to the dance camp must not contain any nut products.

I have read through this form and entered all information correctly regarding 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.
Date

MonthDayYear
Date
Signature*

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Dance Camp Registration

Student Information