Oz Summer Registration Form

Downtown Dance: Wizard of Oz Summer Dance Camp Registration Form

Please fill in the form below.
Dancer's Name*

First NameLast Name
How did you hear about us?*
Camp T-Shirt Size*
Dancer's Age at camp*
Birth Date*
Sex*

FemaleMale
Guardian's Full Name*
E-mail*
Secondary Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
Does the dancer have any medical problems we should be aware of?*
Oz Class Selection*

Rainbow Ballet (ages 4-5)Munchkins Ballet (ages 5-7)Munchkins Tap (ages 6-8)Yellow Brick Rd Jazz (ages 8-12)Yellow Brick Rd Hip Hop (ages 8-12)Emerald City Ballet/Lyrical (ages 9-13)
Will you be attending the Thursday, May 27, 6-7pm main character audition? (circle one) Yes / No *You must be at least 8 years old to audition.*
If Yes, please select which characters you are auditioning for

Dorothy (open)Scarecrow (open)Lion (open)Tin Man (tap)Glinda (ballet/lyrical)Wicked Witch (ballet/lyrical)
Emergency contact/relation*
Emergency Contact Phone*

Area CodePhone Number
I hereby release Downtown Dance, employees/independent contractors from all liability for personal injury, illness, or property damage occurring on or off the studio’s premises. I authorize Downtown Dance to seek medical treatment at the nearest medical facility and they may call paramedics and discharge me/my student to an ambulance if I am not able to authorize it in case of a medical emergency. I certify that my student is in good health and capable of participating in physical activities.
I hereby give permission to Downtown Dance to take and use photographs for promotional uses for the studio.

I understand that payment is not refundable after June 1, 2016.
Guardian's Full Name (Signature to this agreement)*
Date*
Please refer to the Wizard of Oz flyer in paper or on www.downtowndance.org if you're not sure which payment option to select or if you don't have enough info. You may either pay in half or in full at the time of registration. If you choose to pay half, the remaining half is due by June 1, 2016.

The Yellow Brick Road class is the only class you may participate & perform in both dance styles, jazz & hip hop. The dates & times are the same, an extra half-hour each day.
My Products
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Rainbow Camp Full Payment$160.00

Rainbow Camp Half Payment$80.00

Emerald City, Yellow Brick Rd, Munchkins Full Payment$220.00

Emerald City, Yellow Brick Rd, Munchkins Half Payment$110.00

Yellow Brick Road (Both Jazz & Hip Hop) Full Payment$270.00

Yellow Brick Road (Both Jazz & Hip Hop) Half Payment$135.00
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Downtown Dance: Wizard of Oz Summer Dance Camp Registration Form