Clone of D2D Student Registration Form

Dare to Dream Dance Center

471 Pompton Avenue, Cedar Grove, NJ, 07009

njdaretodreamdance@gmail.com

www.daretodreamdance.com

(973) 498-0009
Youth Summer Dance Camp 2026

NOTE: The first 2-Weeks Camp Fee + $25.00 Registration fee due upon enrollment.
Student Registration Form

(Complete ONE registration form for each student)
Date

MonthDayYear
Date

Student Full Name

First NameMiddle NameLast Name
Student Cell Number
e.g. 11183021
Student Age
e.g. 11183021
Birth Date

MonthDayYear
Present Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student Email
Student Parent Name - Mother (Adult students enter n/a)

First NameLast Name
Student Parent Phone Number - Mother
Please enter a valid phone number.Format: (000) 000-0000.
Student Parent Address - Mother

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Parent Name - Father (Adult students enter n/a)

First NameLast Name
Student Parent Phone Number - Father
Please enter a valid phone number.Format: (000) 000-0000.
Student Parent Address - Father

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact

First NameLast Name
Relationship
ex. Father, Mother, etc.
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Is this a cellphone number that can receive emergency text?
Emergency Contact Email
example@example.com

Youth Summer Dance Camp 2026