Summer Dance Camp
June 10 - 14, 2019 (Camp Candyland) // July 15 - 19, 2019 (Pajama Party!)
Student(s) Information
Student #1 Name *
Your answer
Student #1 Date of Birth *
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Student #1 Age *
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Which camp(s) will student #1 be attending? *
Required
Student #2 Name
Your answer
Student #2 Date of Birth
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DD
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YYYY
Student #2 Age
Your answer
Which camp(s) will student #2 be attending?
Student #3 Name
Your answer
Student #3 Date of Birth
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DD
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YYYY
Student #3 Age
Your answer
Which camp(s) will student #3 be attending?
Parent/Guardian's Information
Parent/Guardian's Name *
Your answer
Parent/Guardian's Street Address *
Your answer
Parent/Guardian City, State, Zip Code *
Your answer
Parent/Guardian's Email Address *
Your answer
Parent/Guardian's Primary Phone *
Your answer
Parent/Guardian's Secondary Phone *
Your answer
Health Information
Any medical history your child has that TDC should be aware of? If so, please list the child's medical history. *
Your answer
Any allergies your child has that TDC should be aware of? If so, please list the allergies and describe the severity of the allergy. *
Your answer
Will your child need to take prescription medication while at camp? If so, there will be a separate form to fill out on the first day of camp. *
Your answer
Emergency Contacts
Emergency Contact #1 Name *
Your answer
Emergency Contact #1 Relation to Student *
Your answer
Emergency Contact #1 Phone Number *
Your answer
Emergency Contact #2 Name *
Your answer
Emergency Contact #2 Relation to Student *
Your answer
Emergency Contact #2 Phone Number *
Your answer
Authorized Pick-Up
Persons authorized to pick-up the child/children, other than parents and emergency contacts. Picture ID is required upon pick-up. Please include their name and phone number.
Your answer
Payment Information
No refunds, no returns. We will transfer your tuition, if applicable, from one camp date to another but it will not be applied towards any dance tuition.
The $25.00 registration fee is due upon completing this registration form.
Tuition must be paid in full 30 days prior to the event.
Week 1 (June 10th - 14th) due Friday, May 10th
Week 2 (July 15th - 19th) due Saturday, June 15th
Credit Card Type *
Credit Card Number *
Your answer
Credit Card Expiration Date *
Your answer
Credit Card Security Code (CCV) *
Your answer
Credit Card Zip Code *
Your answer
Terms & Conditions
Please read the following carefully. Your signature verifies that you have read, understand, and accept all of Tammy’s Dance Company’s terms & conditions.
• I acknowledge that I am 18 years or older, that I am registering myself or on behalf of my child who is under 18 years old (either party to be called I), that I am in good health and capable of undergoing the course of exercise and/or dance for which I am enrolling at Tammy's Dance Company • I acknowledge that I have been advised by Tammy's Dance Company to seek a professional medical consultation for any medical, physical, emotional problems that may affect my ability to exercise and/or dance. • I realize that there are no returns or refunds on camp tuition after registration has been processed • Tammy's Dance Company realizes that I assume all responsibility and risk for any injury or damages which I might sustain either directly or indirectly from any cause whatsoever related to the course of exercise and/or dance I participate in at Tammy's Dance Company. • I hereby discharge and release Tammy's Dance Company, any of it’s members, faculty, and/or employee and representative from any and all matters of action, suits, liens, debts, agreements, promises, liabilities, claims, rights, obligations, damages, losses, and damages of any nature whatsoever, known or unknown, which I now have or may here after have against any person of Tammy's Dance Company. • I realize that I am responsible for all personal belongings which I bring into Tammy's Dance Company’s facility. Tammy's Dance Company is not liable for my personal belongings. • I give Tammy's Dance Company permission to use photography and/or videography for promotional use. • I acknowledge that upon competing this form the $25.00 registration fee is due. • I understand that I am not registered for Tammy’s Dance Company’s “Summer Dance Camp” until payment is made in full, 30 days prior to the start date of the camp. • I acknowledge that I have carefully read and understand this entire document before signing it and by signing below I agree to all stated terms and conditions. *
By typing your first and last name below, signifies you are completing this form using an electronic signature. By signing electronically, certifies that you have read, understand, and agree to all of the terms listed above. *
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