SUMMER CAMP FORMS
*If you would like to save time and print out the registration form to fill out at home, please feel free to do so. Below are two different forms. The first one is for our Summer Camps and the second one is for our Special 6 Week Set Of Saturday Classes*
-Form #1: SUMMER CAMP REGISTRATION FORM:
(Please use one form for each student)
Today’s Date: ____/____/____
STUDENT’S NAME______________________________ DOB___/___/___
AGE_______
ADDRESS_____________________________CITY________________ZIP_______
HOME PHONE_______________________ E-MAIL__________________________
MOTHER’S NAME_____________________ WORK or CELL____________________
FATHER’S NAME______________________ WORK or CELL____________________
ADDITIONAL EMERGENCY CONTACTS
Name:___________________ Phone #:_______________ Relationship:____________
Name:___________________ Phone #:_______________ Relationship:____________
ADDITIONAL PEOPLE ALLOWED TO PICK UP YOUR CHILD
(IF YOUR CHILD DRIVES THEMSELVES, PLEASE INDICATE BELOW)
Name:___________________ Phone #:_______________ Relationship:____________
Name:___________________ Phone #:_______________ Relationship:____________
Name:___________________ Phone #:_______________ Relationship:____________
SCHOOL CURRENTLY ATTENDING: _____________________________
GRADE LEVEL: _________
HOW DID YOU HEAR ABOUT US? _______________________________
DOES YOUR CHILD HAVE ANY HEALTH OR ALLERGY CONDITIONS? ______
IF YES, PLEASE INDICATE DETAILS:______________________________________
___________________________________________________________________
DOES YOUR CHILD HAVE ANY PREVIOUS INJURIES WE SHOULD BE AWARE OF?___
IF YES, PLEASE INDICATE DETAILS:______________________________________
___________________________________________________________________
WHAT SIZE T-SHIRT DOES YOUR CHILD WEAR (please circle one): XS S M L XL
CAMP SESSION(S) YOU WISH TO REGISTER FOR (please circle one):
SESSION I SESSION II
JULY 8th - JULY 26th JULY 29th – AUGUST 16th
AGE GROUP REGISTERING FOR (please circle one):
MINI CAMP
(AGES 2-4)
A Summer with the Muppets
Monday – Friday
9am - 10am
$295.00 per session
Deposit due: $100.00
DAY CAMP
(AGES 5-13)
A Summer in the New Millennium!
Monday-Friday
10:30am – 5:30pm
$975.00 per session
Deposit due: $295.00
INTENSIVE CAMP
(AGES 14-17)
A Summer of Big Bands
Monday – Friday
6pm - 8pm
$550.00 per session
Deposit due: $150.00
*If enrolling before May 1st, prices will differ ($250 Mini camp, $495 Intensive camp & $795 Day camp)
*Sibling & Multiple camp session enrollments will also be discounted upon sign-up.
*Deposits are due upon sign-up for camps & ALL remaining balance will be due by June 15th.
Are you registering at our studio for the first time? ___ YES ___ NO
If YES, please enclose a $20 Studio registration fee with your application.
Are you a previous student who was NOT enrolled during the last season? ___YES ___NO If YES, please enclose a $10 Studio registration fee with your application.
Will you be needing Extended Morning Day Care? ___ YES ___ NO
If YES, Please include $20 per day needed (circle the weeks & days needed):
Week 1 Week 2 Week 3
Mondays Tuesdays Wednesdays Thursdays Fridays
PAYMENT OPTIONS:
(Circle one) Credit Card / Debit
(Circle one) Visa / Mastercard
Credit Card # _____________________________ Exp. Date _____________
Amount Charged: $________________
Cardholders Signature ___________________________
Print Name ____________________________________
*WAIVER OF LIABILITY
The Performing Arts Group, its agents, employees, staff members, owners, landlords and/or affiliates, individually, are not responsible for accidents or injuries incurred during classes or on dance studio premises. It is the responsibility of the student and/or parent to inform The Performing Arts Group of any physical or emotional disability and/or health problems that may limit there ability and/or behavior in classes.
I have read the above waiver and understand its contents and I agree to release and hold harmless The Performing Arts Group and/or its agents, employees, staff members, landlords, owners and/or affiliates, individually, from any liability whatsoever. I understand that tuition, recital, costume deposits and payments are non-refundable and that payment in full of any and all costumes and tuition is my responsibility. Furthermore, I understand that I have up to 60-days to give notice of withdrawal from the studio after enrollment for that year and that I am responsible for payment of that month after which notice was given. I also understand that my credit card may be charged in that event. I also understand that my credit card will be charged should a costume balance be owed to the studio.
Signature of Parent/Guardian:_________________________ Date:______________
I am the parent/legal guardian of ______________________________(student’s name), who has my permission to visit any area within the property lines of Plaza De Oro provided he/she is accompanied by a faculty member of The Performing Arts Group.
Signature of Parent/Guardian: ________________________ Date:______________
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CONSENT TO COLLECT PERSONAL INFORMATION
The Performing Arts Group has a Privacy Policy with regards to collecting, using, retaining, disclosing and disposing of personal information.
I consent to give The Performing Arts Group permission to gather my personal information.
*WE WILL NOT USE OR SELL YOUR INFORMATION UNLESS OTHERWISE STATED*
Signature of Parent/Guardian:_________________________ Date:______________
From time to time The Performing Arts Group takes photos and/or videos of students either in their performances, or for educational and advertising purposes.
Please sign off on the following: I consent to having my son’s/daughter’s photograph provided to the media (if applicable); for educational purposes; or for ongoing advertising (i.e. Website)
Signature of Parent/Guardian:_________________________ Date:______________
Student’s Name:____________________________
_________________________________________________________________________________
-Form #2: REGISTRATION FORM FOR 6 WEEK SET OF SATURDAY SUMMER CLASSES:
*JULY 8th-AUGUST 17th*
(Please use one form for each student)
Today’s Date: ____/____/____
STUDENT’S NAME______________________________ DOB___/___/___
AGE_______
ADDRESS_____________________________CITY________________ZIP_______
HOME PHONE_______________________ E-MAIL__________________________
MOTHER’S NAME_____________________ WORK or CELL____________________
FATHER’S NAME______________________ WORK or CELL____________________
ADDITIONAL EMERGENCY CONTACTS
Name:___________________ Phone #:_______________ Relationship:____________
Name:___________________ Phone #:_______________ Relationship:____________
ADDITIONAL PEOPLE ALLOWED TO PICK UP YOUR CHILD
(IF YOUR CHILD DRIVES THEMSELVES, PLEASE INDICATE BELOW)
Name:___________________ Phone #:_______________ Relationship:____________
Name:___________________ Phone #:_______________ Relationship:____________
Name:___________________ Phone #:_______________ Relationship:____________
SCHOOL ATTENDING CURRENTLY __________________________
GRADE LEVEL : _________
HOW DID YOU HEAR ABOUT US?_______________________________
DOES YOUR CHILD HAVE ANY HEALTH OR ALLERGY CONDITIONS? ______
IF YES, PLEASE INDICATE DETAILS:______________________________________
___________________________________________________________________
DOES YOUR CHILD HAVE ANY PREVIOUS INJURIES WE SHOULD BE AWARE OF?___
IF YES, PLEASE INDICATE DETAILS:______________________________________
___________________________________________________________________
*SATURDAY CLASSES YOU WISH TO REGISTER FOR:
CLASS TITLE TIME
1)____________________________________________________________
2)____________________________________________________________
3)____________________________________________________________
4)____________________________________________________________
5)____________________________________________________________
6)____________________________________________________________
7)____________________________________________________________
8)____________________________________________________________
Are you registering at our studio for the first time? __YES __NO
(If YES, please enclose a $20 studio registration fee with your application.)
Are you a previous student who was NOT enrolled during the last season? __YES __NO (If YES, please enclose a $10 studio registration fee with your application.)
*PAYMENT OPTIONS:
(Circle one) Credit Card / Debit
(Circle one) Visa / Mastercard
Credit Card # _________________
Exp. Date ____________________
Amt. Charged ________________
Cardholders Signature ______________________________________
Print Name _______________________________________________
*Waiver of Liability
The Performing Arts Group, its agents, employees, staff members, owners, landlords and/or affiliates, individually, are not responsible for accidents or injuries incurred during classes or on dance studio premises. It is the responsibility of the student and/or parent to inform The Performing Arts Group of any physical or emotional disability and/or health problems that may limit there ability and/or behavior in classes.
I have read the above waiver and understand its contents and I agree to release and hold harmless The Performing Arts Group and/or its agents, employees, staff members, landlords, owners and/or affiliates, individually, from any liability whatsoever. I understand that tuition, recital, costume deposits and payments are non-refundable and that payment in full of any and all costumes and tuition is my responsibility. Furthermore, I understand that I have up to 60-days to give notice of withdrawal from the studio after enrollment for that year and that I am responsible for payment of that month after which notice was given. I also understand that my credit card may be charged in that event. I also understand that my credit card will be charged should a costume balance be owed to the studio.
Signature of Parent/Guardian:________________________________
Date: ____________
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THE PERFORMING ARTS GROUP CONSENT TO COLLECT PERSONAL INFORMATION
The Performing Arts Group has a Privacy Policy with regards to collecting, using, retaining, disclosing and disposing of personal information. This policy is available through The Performing Arts Group.
I consent to give The Performing Arts Group permission to gather personal information.
Signature of Parent/Guardian:_________________________________________
Date: ______________
*WE WILL NOT USE OR SELL YOUR INFORMATION UNLESS OTHERWISE STATED*
-From time to time The Performing Arts Group takes photos and/or videos of students either in their performances, or for educational and advertising purposes. Please sign off on the following:
I consent to having my son’s/daughter’s photograph provided to the media (if applicable); for educational purposes; or for ongoing advertising (i.e. Website)
Signature of Parent/Guardian ________________________________
Date______________
Student’s Name____________________________