Summer Camp Enrollment Form

I Am Dance: Summer Camp Registration
STUDENT INFORMATION:
Child Name

First NameLast Name
Birth Date

MonthDayYear
Age
Name of School
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
MEDICAL INFORMATION
Physician Name (optional)

First NameLast Name
Phone Number (optional)

Area CodePhone Number
Medical Concerns
Emergency Contact

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
Years of Dance Training
Former Dance School Attended
Style of Dance Previously Taken

My Products

I Am Dance 2019 Summer Intensive (One Week) + $15 REGISTRATION FEE Product Image

I Am Dance 2019 Summer Intensive (One Week) + $15 REGISTRATION FEE$140.00

Quantity
Item subtotal:

I Am Dance 2019 Summer Intensive (Two Weeks) + $15 REGISTRATION FEE Product Image

I Am Dance 2019 Summer Intensive (Two Weeks) + $15 REGISTRATION FEE$215.00

Quantity
Item subtotal:

Total $0.00

Credit Card

Should be Empty: