2013 Multi-Media Art & Music Camp Registration Form

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*

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.