Summer Camp Registration

Parent/Guardian
*
Mailing Address
*
Zip Code
*
Email Address
*
Primary Phone Number
*
Secondary Contact Name
*
Secondary Contact Phone Number
*
Student Name
*
Student Date of Birth
*
Does your child have any disabilities we should be aware of?
*
Childrens Dance Camp - $85.00 +tax

Age 5-7: July 29-August 2; 10:00am-12:00pm
Dance Camp with Nutcracker Repertory - $155.00 +tax
IL1/2/3: July 8-12; 10:00am-2:30pm
IL4/5/6: July 15-19; 10:00am-2:30pm
IL7/8: July 22-26; 10:00am-2:30pm
Photograph/Videography Consent
*

I DO give permission for photography/videography of my child for use in advertising and/or display purpose. I am willing to release said media into public domain and understand that no monetary compensation will be given for the use of said media.
Parental Consent
*
I herein release my child to participate in dance class and will not hold Mann Dance Academy, Inc. liable for any injury they might incur.
Typed Signature
*
Date
Comments or questions: