This Form cannot be submitted until the missing
fields (labelled below in red) have been filled in
2015 Irish Dance Camp Registration Form
Please note that all fields followed by an asterisk must be filled in.
First Name*
Last Name*
E-Mail Address*
Street Address*
City*
State/Prov*
Zip/Postal Code*
Home Phone*
Student's Name*
Age*
---Select---
6
7
8
9
10
11
12
13
14
15
16
Previous Experience (Styles of dance, Number of Years, etc)
Special Requests/Previous Injuries/Surgeries/Needs/Concerns:
Class Dates
July 27th-30th 9am-3pm
Tuition Policy*
$75 deposit is DUE AT REGISTRATION. Remaining balance is due July 1st. If balance is not received by July 1st, student will lose their place in camp and DEPOSIT IS NON-REFUNDABLE. There is no refund for any days missed during camp. There will be a $15 fee for any returned checks. I have read the Tuition Policy and agree to adhere to it, as well as that all above information is correct.
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