VCBynum Arts Dance Camp Registration

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Camper's Full Name

First NameLast Name

Date of Birth

Date

Age

T-shirt Size, specify Youth or Adult size

Youth S, M, L, XL - Adult S, M, L, XL

What is Your Child's Shoe Size

Shoe Size

Parent/Guardian Full Name

First NameLast Name

Parent/Guardian Email Address

example@example.com

Parent/Guardian Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Relationship to Camper

MEDICAL & EMERGENCY INFORMATION

In the event I cannot be reached in an emergency, I authorize VCBynum Arts & Education staff and designated representatives to secure emergency medical treatment for my child.

MEDIA RELEASE

I grant permission to VCBynum Arts & Education, its staff, partners, sponsors, and representatives to photograph, videotape, and record my child during camp activities. These images and recordings may be used for educational, promotional, marketing, grant reporting, fundraising, website, newsletter, social media, and other organizational purposes.

PARTICIPATION AGREEMENT & LIABILITY WAIVER

I understand that participation in camp activities may involve physical movement, dance, recreation, and other activities that carry inherent risks.

I release and hold harmless VCBynum Arts & Education, its officers, directors, employees, volunteers, contractors, and partners from liability arising from participation except in cases of gross negligence or willful misconduct.

CAMP CODE OF CONDUCT

Participants are expected to:

• Treat instructors, volunteers, and fellow campers with respect.
• Use appropriate language and behavior.
• Follow all safety guidelines.
• Respect camp facilities and equipment.
• Participate positively in activities

All Campers are expected to arrive on time.

VCBynum Arts & Education reserves the right to dismiss participants whose behavior creates safety concerns or significantly disrupts the camp experience.

Has your child previously participated in VCBynum Arts & Education programs?

Please contact inspire@vcbynumarts.org

CAMP FEES:

VCBynum Arts & Education offers competitive pricing, and we believe that every child should have access to quality arts education regardless of financial circumstances. Scholarships are awarded based on available funding, demonstrated need, and our commitment to serving youth who may otherwise be unable to participate.

LEVEL	DESCRIPTION	FEE
Standard Rate	Pay it forward/Help support another youth	$200
Reduced Rate	Program cost is discounted 25%	$150
Community Rate	Reduced tuition	$100
Scholarship tuition	Variable support through grants and donations

SCHOLARSHIPS AVAILABLE

ARE YOU REQUESTING A SCHOLARSHIP?

What level of assistance are you requesting?

PAYMENT

Standard Rate - Pay it forward/support a friend

$200.00 Quantity

Reduced Rate (25% discount)

$150.00 Quantity

Community Rate

$100.00 Quantity

Total

What interests your child most about participating in this camp? What will he/she gain from this experience?

In a few sentences, please tell us how this scholarship would make it possible for you or your child to attend.

Would your family be willing to contribute volunteer time with VCBynum Arts in lieu of a portion of tuition?

Is there anything else you would like us to know?

Parent's Signature

Payment Methods

Debit or Credit Card

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

VCBynum Arts Dance Camp Registration

PAYMENT*

Payment Methods

PAYMENT