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ADMP Summer Dance Intensive Registration Form
Welcome
Thank you for registering for our Youth Dance Intensive!
Please fill out this form to register your student for the summer dance intensive
Child Information
Child's full name
*
Date of birth
*
Age
*
Gender
*
T-Shirt Size
*
Which dance style is your star most excited about?
*
Which dance style is your star most excited about?
Parent/Guardian Information
Parent/Guardian full name
*
Relationship to child
*
Phone number
*
Email address
*
Address
*
Emergency contact if different from above
Emergency contact phone number
Best way to contact you
*
Best way to contact you
A
Email
B
Phone Number
Authorized Pick Up Person(NOTE: Only names listed below will be allowed to pick up students. If their name is not listed below we will not release the student without verbal consent from parent/guardian listed above)
*
*
*
Medical Information
Does your child have any allergies?
*
Does your child have any allergies?
A
Yes
B
No
Does your child have any medical conditions we should know about?
*
Does your child have any medical conditions we should know about?
A
Yes
B
No
Any special instructions or requirements?
Consent and Release
Please check all boxes to provide your consent:
Untitled checkboxes field
I am the parent/legal guardian of the child named above.
*
Untitled checkboxes field
I give permission for my child to participate in the activity(-ies) described above.
*
Untitled checkboxes field
I understand the nature of the activity(-ies) and any associated risks.
*
Untitled checkboxes field
I give permission for emergency medical treatment if necessary.
*
Untitled checkboxes field
I agree to be responsible for any medical expenses incurred.
*
Untitled checkboxes field
I release the organizer from liability for injury or loss during participation.
*
Parent/Guardian signature
*
Draw your signature here
Camp Registration Fee Payment
*
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