2015 Summer Registration Form
Circle camp attending
Junior Camp July 27th to 30th 10:00am to 2:00pm
Dance Camp (Miss America Camp) August 3rd to August 13th 10:00am to 2:30pm
All camps Monday to Thursday
Student Information Name ________________________________________________ Age _________
Date of Birth ________________________ Address__________________________________________
City _______________________________________ State____________ Zip _____________________
Grade ____________ Guardian Name(s) ___________________________________________________
Home Phone ______________________________Cell Phone__________________________________
E-Mail Address 1 (Required) ____________________________________________________________________________________
Please list any medical conditions or physical limitations
_____________________________________________________________________________________
Please list any previous dance training (what school, subject, and how long)
_____________________________________________________________________________________
How did you hear about our school?
________________________________________________________________________
Emergency Contact Information (other than listed above)
Name____________________________________________________
Phone_______________________________________
I (parent or guardian) hereby declare that I have received a brochure and have read it in its entirety. I understand and agree to abide by all rules set forth by TLC Academy of Dance. In recognition of the physical demands of dance and gymnastics, I hereby knowingly, freely, and voluntarily waive any right or cause of action of any kind whatsoever, arising as a result of such activity from which any liability may or could accrue to Tim Chester, TLC Academy of Dance, or its agents. I also understand that photographs may be used for our annual brochure, website, and other advertising collateral.
X_________________________________________________________
Date__________________________________ (Parent/Guardian Signature)
Junior Camp $145 ________
Dance Camp $345 ________
Number of Students _______
Total ________
Ask about the Sibling discount.
Circle camp attending
Junior Camp July 27th to 30th 10:00am to 2:00pm
Dance Camp (Miss America Camp) August 3rd to August 13th 10:00am to 2:30pm
All camps Monday to Thursday
Student Information Name ________________________________________________ Age _________
Date of Birth ________________________ Address__________________________________________
City _______________________________________ State____________ Zip _____________________
Grade ____________ Guardian Name(s) ___________________________________________________
Home Phone ______________________________Cell Phone__________________________________
E-Mail Address 1 (Required) ____________________________________________________________________________________
Please list any medical conditions or physical limitations
_____________________________________________________________________________________
Please list any previous dance training (what school, subject, and how long)
_____________________________________________________________________________________
How did you hear about our school?
________________________________________________________________________
Emergency Contact Information (other than listed above)
Name____________________________________________________
Phone_______________________________________
I (parent or guardian) hereby declare that I have received a brochure and have read it in its entirety. I understand and agree to abide by all rules set forth by TLC Academy of Dance. In recognition of the physical demands of dance and gymnastics, I hereby knowingly, freely, and voluntarily waive any right or cause of action of any kind whatsoever, arising as a result of such activity from which any liability may or could accrue to Tim Chester, TLC Academy of Dance, or its agents. I also understand that photographs may be used for our annual brochure, website, and other advertising collateral.
X_________________________________________________________
Date__________________________________ (Parent/Guardian Signature)
Junior Camp $145 ________
Dance Camp $345 ________
Number of Students _______
Total ________
Ask about the Sibling discount.
Junior Camp Tuition
$145.00
$145.00
Miss America Dance Camp
$345.00
$345.00
