Registration
Join us at The Rohanna Movement to combine dance and fitness for a riot of FUN! Theme days, dress up, games and crafts are just a few of the fun activities in store! Ages 6-10 August 5-9, 9am-1pm $150 for the week.
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Home Phone: Cell #: Work #:
Email: (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Allergies or Medical Information the staff should be informed of?*
Contact #1 Last Name This person you are authorizing as an emergency contact/ authorized pickup if you cannot be reached.*
Contact #1 Phone (best reached)*
Contact #1 Email*
Contact #1 Relationship to student*
Contact #2 First Name This person you are authorizing as an emergency contact/ authorized pickup if you cannot be reached.
Contact #2 Last Name
Contact #2 Phone (best reached)
Contact #2 Relationship to student
 
Additional Information:
 
Payment Policy
Personal checks will be accepted at the front desk. If you are paying with a check please make your checks payable to The Rohanna Movement.

Camp Fees are due PRIOR to the first day of camp.

I've read the above and agree.
 
Release of Liability
I hereby agree to assume all risks attendant upon myself and/or my child while participating in any class at The Rohanna Movement LLC. I hereby waive, release, and discharge any and all claims for damages for death, personal injury or property damage which I or my child may have, or which may hereafter accrue to me or my child, as a result of my child’s participation in any class at The Rohanna Movement LLC. I agree to save and hold harmless from liability The Rohanna Movement LLC. and any of their teachers or volunteers by reason of death, injury or damages to persons or property, which my child or I may suffer while participating in class.
I've read the above and agree.
 
Medical Emergencies
I fully understand that The Rohanna Movement’s instructors, and employees are not physicians or medical practitioners of any kind. With the above in mind, I hereby release and grant permission to the The Rohanna Movement's Staff to render temporary first aid to my child in the event of any injury or illness, and if deemed necessary by the The Rohanna Movement's Staff to call a doctor to seek medical help, including transportation by a The Rohanna Movement Staff member, whether paid or volunteer, to any health care facility or hospital, or the calling of an ambulance for said child should the The Rohanna Movement Staff deem this to be necessary.

I've read the above and agree.
 
Photo & Video Release
I understand and agree that The Rohanna Movement reserves the right to take and use videos and photos of participants, free of charge, to be used for publicity purposes in The Rohanna Movement’s annual dance recital program and/or other media publications.
I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number:  
Name as it appears on card:
Nickname:
Card Expiration Month:   Exp Year:
Address Line 1: Address Line 2:
City: State: Zip: