Unbound Dance Academy

Freedom to Express, Freedom to Grow, Freedom to Excel

 

SUMMER CAMP 2018 REGISTRATION FORM

Unbound Dance Academy

1181 Hooksett Road Hooksett, NH 03106

 

 _________  Princess/Pirate Camp (ages 4-7) JULY 9-13 8:30am-4:00pm cost: 225.00 (After hours pick-up available till 4:30pm 15.00 a day)

   

__________ Peter Pan: A Musical Theater Experience (ages 7-14) July 16-20 7-14 8:30am-4:00pm cost: 225.00         

 

 _________  Dance Xplosion Camp (ages 8-12) AUGUST 6-10  8:30am-4:30pm cost: 225.00                                         

 

 ________  Senior Ballet Intensive (ages 12-17) July 23-25 9:30am-3:30pm cost: 140.00                

 

______   Junior Ballet Intensive (ages 7-11) August 1-3 9:30am-3:00pm cost: 140.00                 

 

 

STUDENT NAME: ___________________________________________________________________  DATE OF BIRTH: ________________________

ADDRESS: _______________________________________CITY: _____________________ZIP: ____________________ 

TELEPHONE: _____________________________             EMAIL: _______________________________

 

 

 

Are there any special needs/medical conditions?   YES      NO   If Yes, Please Explain:

 

 ____________________________________________________________________________________________________________________________________________________________________________________________________________

 

Who should we contact in case of emergency? ____________________________              Telephone: ______________________

 

I, the undersigned, do hereby waive all claims against the owner,, instructors, and assistants, individually or otherwise, of Unbound Dance Academy  LLC for any injuries he/she may sustain while attending or participating in said programs. In the event that my child sustains an injury requiring immediate medical attention, I understand that Unbound Dance Academy, LLC. will make every reasonable effort to contact the individual noted above. However, in the event that the emergency contact cannot be reached, I do hereby grant Unbound Dance Academy LLC. the authority to administer first aid and/or contact emergency personnel.

 

 

____________________________________________________________________________

Signature (Parent or Guardian)

 

 

PHOTO RELEASE: Unbound Dance Academy LLC may take photos or video to promote the studio. Photos may be published in our program literature, on our website, or used on local television stations or in local newspapers. Please check one of the following and sign below.

 

 ________        I give permission for photos/videos to be taken.    

 

 

________       I do not give permission for photos/videos to be taken.         

 

 

 

 

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Signature (Parent or Guardian)                                                 Date