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Summer Camp Registration Form
Name:
Age:
Male
Female
Phone:
Email:
Address:
Town/City:
Postal Code:
Dance Studio:
a.h.c. #
Emergency Contact:
Emergency Phone:
Please Select One:
Junior Program
@ $600.00
Intermediate1
@ $600.00
Intermediate2
@ $600.00
Senior
@ $600.00
What size camp shirt would you like? (included in fees):
Child (10-12):
Adult sm:
Adult med:
Adult lg:
Adult xl:
Will there be family members on the raft?
Yes
No
How Many?
*cost per extra person is $30.00 - please include payment with registration
If you want to be a dorm mom then fill out the fields below otherwise proceed to pay Payment
Any health concerns we should be aware of:
Would you like to be a dorm mom?
Yes
No
*Please send an application letter with this registration form. We will notify you with confirmation, as positions for dorm moms are limited.
Your shirt size:
S
M
L
XL
Payment
Summer Camp:
$
($600 for the registrant)
Accomodation and Meals
$
($200 for the registrant)
Added rafting participants
($30.00 per guest)
$
($30 per additional guest)
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