Summer Camp Registration

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Child's Name First Last
Child's Age / MM / DD YYYY
Email
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home Phone - (###) - ### ####
Mother's Name
Cell Phone - (###) - ### ####
Father's Name First Last
Cell Phone - (###) - ### ####
Summer Camp Selection
Princess & Super Hero Camp Session 2 ----SOLD OUT---- Session 3 – Aug 8th – 12th Session 4 – Aug 22nd– 27th
Summer Dance Intensive August 17th - 19th Junior 6 - 9yrs Inter 10 - 13yrs Senior 14 +
Mini age 5 - 8 Junior age 8- 11 Inter age 11 - 13 Senior age 14 +
Acro Intensive August 2nd - 5th Mini 5 - 8yrs Junior 8 - 11yrs Inter 11 - 13yrs Senior 14 +
Mini age 5 - 8 Junior age 8- 11 Inter age 11 - 13 Senior age 14 +
Payment Information Credit Card Check
Credit Card
Exp. Date
cvv (3 digit number located on the back of the card)
Disclaimer
The undersigned acknowledges that he/she is the parent/guardian responsible for the above named student’s fees for the 2011 camp, and further acknowledges the receipt of the rules and regulations for Performing Dance Arts Ltd. and agrees to abide by said rules and regulations. Neither Performing Dance Arts Ltd. nor its representatives shall be held responsible for any injury, accident, or claim for damages Arising from any accident or injury which are caused by or arise from participation of the student during any program, class, or rehearsal in any facility or in any location where Performing Dance Arts Ltd. is located or participating. The Undersigned acknowledges acceptance of this condition. Performing Dance Arts Ltd. reserves the right to use any Photos, video Footage or the like for publicity and marketing of Performing Dance Arts Ltd. if so desired. I Agree
Additional Commentss

Summer Camp Registration

Summer Camp Registration

Summer Camp Selection

Disclaimer