1-3pm Session: Election Day Dance Clinic Registration Form

Election Day Dance Clinic Registration Form

Fundraiser presented by: Staples Dance Booster Club, Inc
Staples Dance Team: Election Day Dance Clinic

Get ready to dance, have fun, and kick off our first-ever Wreckers Election Day Dance Clinic! 🎉 Dancers will learn exciting jazz and hip hop combinations, taught by current Staples Dance Team Varsity and JV members, while making new friends and bringing their best energy to the dance floor!

Who: Open to K–5 future Wreckers dancers

Date: Tuesday, November 3, 2026 (WPS closed)
Time: 1:00 PM–3:00 PM
Check-in begins at 12:45 PM

Location: Westport's Academy of Dance
1200 Post Road East, Building D

Cost: $45 early registration // $60 at the door (subject to capacity). Non-refundable.

Capacity: 75 dancers

Registration closes Friday, October 30th.

Notes:
Please bring a refillable water bottle.
No food will be permitted onsite.
No street shoes will be permitted on studio flooring. Dancers have the option to dance in jazz shoes, dance specific sneakers, or socks.
Wear comfortable dancing clothes. School clothes are fine, and camp T-shirts will be provided.
Camper Information
Camper Name

First NameLast Name
Grade Level
School Name
T-shirt size (Youth)
Medical Information
Please let us know if your camper have any allergies, existing illnesses or any medical conditions.
Is your camper currently taking any medication? If yes, please provide the generic name and its purpose?
Parent/Guardian Details
Parent/Guardian Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Emergency Contact Details

If parent/guardian cannot be reached.
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number
Media Release

PHOTO/VIDEO Opt-Out (for Promotional Use) Staples Dance Booster Club, Inc may take photos during the Staples Dance Team: Election Day Dance Clinic to be used in promotional materials, including social media and team marketing.
Please indicate your level of consent below:
Acknowledgment, Authorization, and Waiver
Waiver and Release
By providing your signature on this form you confirm:
- The questions listed above have been answered accurately and truthfully.
- By signing below, I acknowledge that I have read and fully understand the attached Waiver and Release, and I voluntarily agree to its terms.
Parent/Guardian Signature
Donation Amount

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USDA non-refundable registration fee of $45 covers your child’s participation in the clinic. Because this clinic is an important fundraiser for the Staples Dance Team, we are grateful for any additional support you may wish to provide. If you would like to make an additional donation beyond the $45 registration fee, simply enter the total amount you would like to pay above. Every contribution is truly appreciated and helps support our team!
Payment Methods

Choose from one of the PayPal options to make your payment.
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Election Day Dance Clinic Registration Form

Camper Information

Medical Information

Parent/Guardian Details

Emergency Contact Details

Media Release

Acknowledgment, Authorization, and Waiver

Donation Amount*

Payment Methods

Donation Amount