In Motion Dance Center

Fill out one registration form for each student.

IN MOTION DANCE CENTER

SUMMER DANCE CAMP 2016 REGISTRATION

ADVANCED DANCERS

A 50% NON-REFUNDABLE payment of the total camp cost must accompany this registration form. Remainder due on first day of camp.

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Student’s Name______Home Phone #______Birth Date ______Age ______School attending fall 2016 ______Grade ______Home Address ______street city zip E-Mail Address ______Cell Phone Mother ______Father ______

Mother’s Name______Employer & Phone#______May we contact you @ work?______

Father’s Name______Employer & Phone#______May we contact you @ work?______

If parents cannot be reached, emergency contact: ______Phone #______

Does student have any food allergies? Indicate yes or no _____ If yes, please list ______

Please Note: In Motion may use pictures of classes, camps and events on our web site or in our monthly newsletters. ************************************************************************************************************

ADVANCED DANCER CAMPS

COST: $190.00 PER WEEK MONDAY - FRIDAY

PLEASE MAKE YOUR CAMP SELECTION BELOW. CHECK THE APPROPRIATE WEEK(S) OF CAMP PREFERRED.

July 11 – 15 ______Monday - Friday / 9:00am-12:30pm

July 25 – 29 ______Monday - Friday / 9:00am-12:30pm

August 8 - 12 ______Monday - Friday / 9:00am-12:30pm

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