2019 Summer Registration Form
Once this form is received and processed an invoice will be emailed to the email listed below. Payment can be made online through the invoice or on the first day of camp. Dancers will not be able to participate in any camp activities without payment being made. We can't wait to see you this summer!
Dancer's First and Last Name *
Your answer
Dancer D.O.B *
MM
/
DD
/
YYYY
Parent/Guardian First and Last Name *
Your answer
Parent/Guardian Email: *
Your answer
Cell Phone Number *
Your answer
Any Injuries or Illness? *
Your answer
Wavier
Participation in any Impact Performing Arts activity on or off site, and use of recreational facilities involves risk of accidental injury despite all safety precautions. Having been informed of the activities conducted by Impact Performing Arts, I/we, as individual or as a parent or guardian of the participants named herein, assume all risks and hazards incidental to the activities, and release from responsibility and agree to indemnify and hold harmless Impact Performing Arts, its officers, directors, independent contractors, volunteers and all employees for any illness or injury to me or my child or family members accruing during his/her/our participation in any activity or use of any recreational facility at or conducted by Impact Performing Arts. I also agree to the use of my child’s photo/video for Impact Promotional purposes.

Printing name below will serve as your signature.

I agree to the wavier above. Parent/Guardian (Print Name) *
Your answer
Select Camps *
Required
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