SUMMER CAMP REGISTRATION

NOTE: IF YOU ARE REGISTERING MORE THAN ONE CHILD YOU WILL NEED TO FILL OUT AND SUBMIT FORMS FOR EACH CHILD.

FILL OUT EVERY SECTION OR YOUR FORM WILL NOT SUBMIT!!!!

DANCERS NAME: *

PRIMARY EMAIL: *

HOME PHONE: *

STREET ADDRESS: *

CITY, STATE, ZIP: *

ALLERGIES OR MEDICAL CONDITIONS: *

PARENT / GAURDIAN NAME: *

PRIMARY PHONE: *

ADDITIONAL PHONE: *

EMERGENCY CONTACT NAME: *

RELATIONSHIP TO DANCER: *

PRIMARY PHONE: *

ADDITIONAL PHONE *

NAME & RELATIOSHIP OF ALL INDIVIDUALS AUTHORIZED TO PICK UP DANCER: *

PLEASE LIST THE NAME OF EACH CAMP YOU ARE REGISTERING THIS DANCER FOR: *

ADD PRE CARE (YES / NO): *

ADD POST CARE (YES / NO): *

COMMENTS / ANY ADDITIONAL INFORMATION WE NEED TO KNOW:

WAIVER & RELEASE 

Please enroll my child in the above listed Joyful Motion Summer Dance Programs.  I understand that all deposits are non-refundable and that my balance will be due in full on or before  June 1st, 2011.  In case of a medical emergency I understand that an effort will be made to contact a guardian, but if one is not able to be reached, I hereby give permission for my child to be treated. I hereby indemnify and hold harmless against any and all claims of damages arising out of taking or use of pictures of my minor child during Joyful Motion classes, events or performances. Furthermore I agree to hold harmless Alycia Carlson, Joyful Motion, its agents and employees in the event of an injury occurring to my child during any activities associated with Joyful Motion. I recognize that participating in this or any physical activity has a certain amount of risk and that an injury is always possible. I certify, to the best of my knowledge, that my child is physically able to participate in this activity.  I hereby affirm that I have read and fully understand and agree to the above.