DANCEcamp Registration Form
Please use a separate form for each student
Student Name____________________________________Birth Date____________________
Parents Name(s)______________________________________________________________
Street Address_______________________________________________________________
City___________________________________State__________Zip Code_______________
Daytime Phone________________________________________________________________
Evening Phone________________________________________________________________
Email Address________________________________________________________________
I am registering for the following camp:
_______ DANCEcamp I for 4 to 6 year olds - Nutcracker
June 29 - July 3 9:00 - 11:00 a.m.
_______ DANCEcamp II for 7 to 10 year olds - Coppelia
June 15 - 18 5:30 - 8:30 p.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:______________________________________Exp Date:_________
Signature___________________________________________________________
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