Registration

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Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info (Not Contact #1 or #2)

Students entered below will be added to your family's account

Add New Student #1:

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	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)
	Student Email:
	School:	Grade Level:
	Disabilities (Leave blank if NONE):
	Allergies (Leave blank if NONE):
	Medications (Leave blank if NONE):

Questions/Options:


Are you a current student at Dance & Company?*
How did you hear about this camp?*
Do you have any dance experience? No experience required!*
Do you have any food allergies or medical conditions that are important for camp counselors to be aware of?*

Additional Information:

Camp Agreement

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I've read the above and agree.

Camp Waiver

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Photography/Videography
I understand that Dance & Company has the right to take photos or videos of me (my child) during camp and post them to our social media accounts, blog and website, as well as for advertising purposes inside and outside of the studio premise. The photos will only be of appropriate nature, related to dance or dance activities.

Dance & Company reserves the right to cancel, combine or reschedule classes due to government mandates, weather, last minute teacher absence or for any other reason deemed necessary.

Potty Breaks - All parents/guardians of our younger dancers understand that: For those who need assistance in the restroom with clothing or otherwise during camp hours while no parent/guardian is present, Dance & Company staff will assist with potty breaks as needed. We will take the lead from your dancer(s) as to how much assistance is required.

Furthermore, I understand that while participating in Dance & Company's dance/fitness program Dance & Company employees may need to occasionally physically correct me (or my child) to show proper placement in an exercise/movement which will ultimately help prevent injuries.

I AM AWARE AND UNDERSTAND THAT I (OR MY CHILD) WILL BE PARTICIPATING IN A DANCE CAMP/FITNESS PROGRAM WITH DANCE & COMPANY THAT WILL REQUIRE SOME PHYSICAL EXERTION. ALTHOUGH THE MOST COMMON INJURIES OR SYMPTOMS ASSOCIATED WITH EXERCISE INVOLVE SPRAINS, STRAINS, DIZZINESS, FAINTING, AND/OR DISCOMFORT IN BREATH, I RECOGNIZE THAT THERE IS A RISK OF SERIOUS INJURY ASSOCIATED WITH ANY DANCE/FITNESS PROGRAM. I ACKNOWLEDGE THAT ANY INJURIES THAT I SUSTAIN MAY BE COMPOUNDED BY NEGLIGENT EMERGENCY RESPONSE OR RESCUE OPERATIONS OF DANCE & COMPANY. I ACKNOWLEDGE THAT I AM KNOWINGLY AND VOLUNTARILY PARTICIPATING IN THE ACTIVITIES WITH AN EXPRESS UNDERSTANDING OF THE DANGER INVOLVED AND HEREBY AGREE TO ACCEPT AND ASSUME ANY AND ALL RISKS OF INJURY, DEATH, OR PROPERTY DAMAGE, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF DANCE & COMPANY, OR OTHERWISE.
I understand that by acknowledging this statement, I (or my child) am agreeing not to hold Dance & Company or any of its employees, owners, agents or insurers responsible for bodily injury that they may suffer as a result of participation in a dance camp/fitness program through Dance & Company.

I've read the above and agree.

Enter your Full Name: