2017 Summer Dance Camps
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Let’s Dance Studio
111 East High St., Glassboro NJ 08028
Summer dance camp registration form

Age

Zip

1 hour weekly class 5 week session 7/18 - 8/16
$50.00
Student teachers camp 7/17 - 7/21
$185.00

Please complete both sides & return with a 50% deposit to reserve class placement.



Let’s Dance Studio
RELEASE AND WAIVER FORM

I understand that dance and tumbling activities as conducted and taught at the studio have inherent risks of injury. These risks include muscle pain, pulls, broken bones, ankle injuries and other personal injury. I recognize the student is exposing herself/himself to such risks when undertaking dance and tumbling activities. I understand that these risks cannot be fully eliminated without jeopardizing the essential qualities of the activity. The student and I assume and accept all risks of injury or damage resulting in such dance and tumbling activities. The student’s participation in this activity is purely voluntary, and the student elects to participate, and I join in that election, in spite of the risks.

I further understand that I’ve been advised of the need for the student to be covered by adequate insurance to cover any injury or damage that may be suffered while participating, and I have obtained such insurance or I agree to bear the cost of any such injury or damage myself.

By signing and dating this Release, I confirm that I have read the Release in full, that I understand its terms, and that I agree with those terms.

I, (parent/guardian’s name) hereby give permission for any and all medical attention to be administered to my child (child’s name) in the event of accident, injury, sickness, etc., under the direction of the physician(s) listed below or at any necessary emergency facility, until such time as I may be contacted. I also assume the responsibility for the payment of any such treatment. This release is effective for the period of one year from the date given below.

INSURANCE COMPANY:

POLICY NUMBER:

CHILD’S PHYSICIAN:

PHYSICIAN ADDRESS:

PHYSICIAN PHONE:

SIGNATURE (PARENT/GUARDIAN): ________________________________________________

DATE: