<p> Fill out one registration form for each student.</p><p>IN MOTION DANCE CENTER</p><p>SUMMER DANCE CAMP 2016 REGISTRATION</p><p>ADVANCED DANCERS</p><p>A 50% NON-REFUNDABLE payment of the total camp cost must accompany this registration form. Remainder due on first day of camp.</p><p>***********************************************************************************************************</p><p>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 ______</p><p>Mother’s Name______Employer & Phone#______May we contact you @ work?______</p><p>Father’s Name______Employer & Phone#______May we contact you @ work?______</p><p>If parents cannot be reached, emergency contact: ______Phone #______</p><p>Does student have any food allergies? Indicate yes or no _____ If yes, please list ______</p><p>Please Note: In Motion may use pictures of classes, camps and events on our web site or in our monthly newsletters. ************************************************************************************************************</p><p>ADVANCED DANCER CAMPS</p><p>COST: $190.00 PER WEEK MONDAY - FRIDAY</p><p>PLEASE MAKE YOUR CAMP SELECTION BELOW. CHECK THE APPROPRIATE WEEK(S) OF CAMP PREFERRED. </p><p>July 11 – 15 ______Monday - Friday / 9:00am-12:30pm</p><p>July 25 – 29 ______Monday - Friday / 9:00am-12:30pm </p><p>August 8 - 12 ______Monday - Friday / 9:00am-12:30pm</p><p>*****************************************************************************</p>