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Home
Students | Parents
Tuition
Class Levels
>
Class Level Descriptions
Dress Code
Studio Polices & Procedures
Studio Closures/Season Dates
Gallery
Schedule
Meet the Instructors
Contact
Summer 2016 Student Registration Form
*
Indicates required field
Student Name
*
First
Last
Gender
*
Female
Male
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Date of Birth (MM/DD/YYYY)
*
Summer Camps/Workshops Attending
*
Sea of Fun - $65 / Royal Tea Party - $20
Take Me to Broadway - $100 / Sleepover - $15
Hip-Hop Workshop w/ Jose
Jazz/Funk/Hip-Hop Workshop w/ Marissa
Check all that apply
***
Payment is due upon enrollment-spot is only reserved once payment has been received. Summer camps can be paid by CASH ONLY***
Parent/Guardian Information
Name #1
*
First
Last
#1 Phone Number
*
#1 Address (If different from student)
*
Line 1
Line 2
City
State
Zip Code
Country
#1 Relationship to Student
*
Mother
Father
Legal Guardian
Other
*If Other, please specify:
*
#1 Email (optional)
*
Name #2
*
First
Last
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#2 Address (If different from student)
*
Line 1
Line 2
City
State
Zip Code
Country
#2 Phone Number
*
#2 Relationship to Student
*
Mother
Father
Legal Guardian
Other
*If Other, please specify:
*
#2 Email (optional)
*
Emergency Contact Info
Name
*
First
Last
Phone Number
*
*Please list anyone in addition to parents/guardians who are permitted to pick up your child:
Name #1
*
First
Last
Phone Number #1
*
Name #2
*
First
Last
Phone Number #2
*
Name #3
*
First
Last
Phone Number #3
*
Student Medical History
Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason?
Student Injury/Medication
*
Yes
No
If YES, please specify:
*
Snacks are served daily, and food will be provided for the Tea Party/ Sleepover (depends on camp).
Is your child allergic to any type of food or drink?
Student Allergies
*
Yes
No
If YES, please specify:
*
Terms of Agreement
PHOTO RELEASE TERMS:
I hereby give permission for my child to be photographed. I understand the photos could be used to share during power point presentations, for promotional purposes including flyers, brochures, newspaper and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of Danica’s School of Dance.
Photo Release Agreement:
*
I agree to the Photo Release Terms
I do not agree to the Photo Release Terms
OFF PROPERTY RELEASE TERMS:
I hereby give permission for my child to go off property with DSD Staff and volunteers to Kissack Ball Field for camp activities
Off Property Release Agreement:
*
I agree to the Off Property Release Terms
I do not agree to the Off Property Release Terms
DSD is not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness per physician orders. Children's’ photos and quotes may be used for publicity purposes. In case of an emergency, and if a family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician).
Parent/Legal Guardian Name
*
First
Last
Date (MM/DD/YYY)
*
Submit
