DANCEcamp Registration Form
Please use a separate form for each student
Name of Student________________________________Birth Date____________________
Name of Parent(s) or Guardian________________________________________________
Street Address_______________________________________________________________
City___________________________________State__________Zip Code_______________
Daytime Phone________________________________________________________________
Evening Phone________________________________________________________________
Email________________________________________________________________________
I am registering for the following camp:
_______ DanceCamp I for 4 to 6 year olds - The Little Humbacked Horse
June 16 - 20 9:00 - 11:00 a.m.
_______ DanceCamp II for 7 to 9 year olds - Don Quixote
June 23 - 27 9:00 - 11:30 a.m.
Method of Payment: (check one)
________ A check for $75.00 is enclosed made payable to Dancer's Studio
________ Please charge my credit card _______Visa _______Master Card
Card Number:______________________________CVV_______Exp Date:_________
(code from back)
Signature__________________________Printed Name_________________________
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