Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Attendee's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Food Allergies
*
We will have a snack each day. Please list any food allergies if applicable.
Safari Adventure Dance Camp Waiver & Media Release
I understand that participation in the Dotty McGill Dance Safari Adventure Dance Camp involves physical activity and carries a risk of injury. I voluntarily assume all risks associated with participation and release, waive, and hold harmless Dotty McGill Dance, its owners, instructors, staff, and volunteers from any and all claims, injuries, damages, or liabilities arising from my child’s participation, except where prohibited by law. I also grant permission for Dotty McGill Dance to photograph and/or record my child during camp and to use these images or videos in print, on its website, and on social media for promotional purposes without compensation.
Signature
*
*Payment will be due August 4th. Cash, Check, or Card accepted.
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