Camps, Events and Performances

Aug
2-5
2010

Hip Hop/Funk Camp

with Ms. Angi DeCurtains

Camp Registration

Today's Date: 9/8/2010

Student's Name:
Age:		Grade (as of 9/1/10):
Parent/Guardian:
Address:
City:
State:		Zip:
Home Phone:		Emergency Phone:
Email Address:

Select the camp options:

Level

Fee

Paid

Company

$ 40

$ 0

Intermediate Level

$ 140

$ 0

Advanced Level

$ 140

$ 0

Please pay this amount:

$ 0

Waiver and Release of Liability

In consideration of my involvement in dance at Balleraena Dance Studio L.L.C., wherever those activities take place, I acknowledge and agree that I risk bodily injury. I knowingly and freely assume all risks, an I, for myself, and for my heirs, assigns, and next of kin, hereby release and hold harmless Balleraena Dance Studio L.L.C. its officers, officials, agents and/or employees, with respect to any and all such injury. I HAVE READ THIS WAIVER AND RELEASE OF LIABILITY, AND UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND I SIGN IT VOLUNTARILY.

Student’s signature:______________________________________________Date:___/___/___

Parent's signature:_______________________________________________Date:___/___/___
(Parental Signature required if student is under 18 years of age.)

Return to Camp Details

Instructions

Fill out this form online then click the PRINT button above.

There are pre-paid, non-refundable registration fees (made payable to Balleraena Dance Studio) for each camp, workshop or special performance your child is taking. This fee is due at the time of registration.