Summer Camp 2026 Forms

PARTICIPANT INFORMATION
Dance Camp 2026
Participant Name
Birthdate

MonthDayYear
Date
Name of School Attended This Year
Select the weeks registering for below
Type a question
Non-Refundable Registration Fee includes Camp T-Shirt Camp Shirt
Please include your child size below for their camp t-shirt
Quantity of Camp T-Shirt
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother/Guardian Name
Home Phone #
Work Phone #
Cell Phone #
Email
example@example.com
Father/ Guardian Name
Home Phone #
Work Phone #
Cell Phone #
Email
example@example.com
Home
Emergency Contact Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Activity Program/Field Trip Liability Release/Authorization
I hereby represent and warrant that if the participant is a minor, I am his/her guardian and authorized to provide the releases, authorizations, and permissions as stated below and all information above is accurate and complete. I hereby give permission for the applicant to participate in all program activities, including field trips in approved vehicles and agree to release Artistic Dance Xpressions, its officers, employees, and agents, from all liability arising from any harm or injury incurred by the participation of my child in the program stated above. Unless otherwise indicated by a parent/guardian in writing at the time of registration, photographs of participants for use in advertisements and publications may be taken while participating in the program activities. No personal information other than the participant's first name will be released under any circumstances except as required by law. By way of copy of this form, I authorize the staff of Artistic Dance Xpressions to obtain medical/hospital treatment for the above participant in the event of an emergency.

If participant is 17 or under:
Print ParentGuardians Name
Signature
Date

MonthDayYear
Date
If participant is 18 or older:
Print Participants Name
Signature
Date

MonthDayYear
Date
Summer Camp 2026

Participant Health Form
HEALTH/OTHER INFORMATION (MUST BE COMPLETED IN ITS ENTIRETY

Please note: The Maryland Department of Health & Mental Hygiene Immunization Certificate must be attached tothis form for any participant (ages 18 or under) who did not attend a Maryland public or private school this year.
Primary Care Provider/Clinic Name
Primary Care Provider/Clinic Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Is the participant exempt from immunizations for religious or medical reasons? If yes, the Maryland Department of Health and Mental Hygiene Immunization Certificate must be completed and attached to this form.
Date of last tetanus or DPT shot (Required by MD State Law for Under 18)

MonthDayYear
Date
Participant Swim Level, please select one
Are there any health issues/concerns staff should be aware of (i.e. seizures, asthma, etc.)
If you answered yes, to the question above please explain below
Is participant allergic to any food? If yes, please list food(s) below
If you answered yes, to the question above please explain below
Please list participant reaction level i.e. severe, mild, moderate
Required treatment
Is participant allergic to any medication? If yes, please list medication(s):
List allergic medications
Please list participant reaction level i.e. severe, mild, moderate
Required treatment
Does the participant have any environmental allergies? (i.e. insect bites, pollen, poison ivy, etc)?
If yes please list allergy
Please list participant reaction level i.e. severe, mild, moderate
Required treatment
Will any emergency medical device be provided e.g. EpiPen, inhaler, insulin pump, etc? If yes, a Day Camp Medication Form must be completed.
Is the participant currently taking any medication? If yes, an additional medical form must be completed. Are there any physical, psychiatric, behavioral, emotional, or developmental concerns staff should

be aware of? If yes, please explain:
If yes please explain
Will you child need assistance to participate, such as, support, adapted equipment, etc?
If yes please explain
Print ParentGuardians Name
Parent Signature
Date

MonthDayYear
Date
Should be Empty:

PARTICIPANT INFORMATION

Summer Camp 2026

HEALTH/OTHER INFORMATION (MUST BE COMPLETED IN ITS ENTIRETY