Summer Dance Camp Registration Form

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K Fortier Studios School of BALLET APETREI

Camper's Name *

Camper's Age *

Camper's Birthdate *

YYYY

Full Address *

Email Address *

Best Contact Phone Number *

Emergency Contact Name & Phone Number *

I am paying by *

Venmo @kfortierstudios

Credit Card

Check

Credit Card Number

Expiration Date

YYYY

CVV

Zip Code

Attending Camp Session

$250 June 2-6 / 9am-2pm "Snow White"

$250 July 21-25 / 9am-2pm "Swan Lake"

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Waiver of Liability: I agree that I will not hold K Fortier Studios or any employee liable for injuries sustained or illnesses contracted while a student at K Fortier Studios. I also agree to pay the total amount due for the camp I have chosen above. By signing below, I agree to be the responsible party for the student listed on this registration form.

Parent or Legal Guardian Signature

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