Summer Camp Registration

Parent/Guardian
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Email Address
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Primary Phone Number
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Secondary Contact Name
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Secondary Contact Phone Number
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Mailing Address
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Zip Code
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Student Name
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Student Date of Birth
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Does your child have any disabilities we should be aware of?
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Camp with Nutcracker Repertory - $200.00 +tax

IL6/7/8 (age 14+): July 7-11; 10:00am-2:30pm
IL4/5 (age 11-13): July 14-18; 10:00am-2:30pm
IL1/2/3 (age 8-10): July 21-25; 10:00am-2:30pm
Children's Camp - $125.00 +tax
Age 5-7: July 28-August 1; 10:00am-12:00pm
Photograph/Videography Consent
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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
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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
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Date
Comments or questions: