Kuchipudi with Aswathi - Summer Camp 2022 Registration

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Please note: Registration is complete once the $100 deposit has been received. Remaining balance of $100 is due by the last day of camp. Zelle and Venmo options are available as well as check payable to Aswathi Konkoth
Zelle (aswathi@gmail.com) or Venmo (@Aswathi-Konkoth)

Student Name: *

Please enter your child's full name.

Please select one of two sessions available: *

August 15 - August 19

August 29 - September 2

Returning Student or New Student? *

Returning Student

New Student

Date of Birth: *

Please enter your child's date of birth. MM/DD/YYYY

YYYY

Home Address: *

Please enter your home address.

Parent #1's Name: *

Please enter Parent #1's name.

Parent #1's Cell Phone Number: *

Please enter Parent #1's cell phone number.

Parent #1's E-Mail: *

Please enter Parent #1's e-mail.

Parent #2's Name: *

Please enter Parent#2's name.

Parent #2's Cell Phone Number: *

Please enter Parent #2's cell phone number.

Parent #2's E-Mail: *

Please enter Parent #2's e-mail.

Please provide any food restrictions/allergies/medical conditions if any.

Please include any comments regarding child's interest or requests in dance.

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