Mini Dance Camp Registration Form

NOW OPEN!

Please submit one form per child.

If you have class placement questions, please email the school email schramelconservatory@gmail.com for guidance.

A student’s placement in the mini dance camp is held once BOTH the registration form (below) and tuition has been paid. Payment available online here.

Student Information

Student Name

First Name

Last Name

Student Birthdate

YYYY

Student Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/ Guardian Information

Primary Contact Name

Primary Parent or Guardian for students under 18 years

First Name

Last Name

Primary Contact Relationship to Child

Primary Contact Phone

(###)

###

####

Primary Contact Email

Secondary Contact Name

Secondary Parent or Guardian for students under 18. In an emergency, the secondary contact will be called if we cannot reach the primary contact.

First Name

Last Name

Secondary Contact Relationship to Child

Secondary Contact Phone

(###)

###

####

Secondary Contact Email

Additional Drop-off/ Pick- Up Contact

If another person typically brings your child to class, please provide their name and phone number.

Name

First Name

Last Name

Phone

(###)

###

####

Procedures and Liability Release

Please read through each statement below. Clicking "Yes" below each statement is required to indicate understanding of each policy.

I understand that dance is a physical art form and injury is inherent. Every effort has been made to keep the studio a safe and appropriate environment for learning and performing dance class. If an injury does occur, the student or student's parent/guardian is responsible for medical expenses incurred and will not hold Schramel Conservatory of Dance liable.

Yes, I understand.

The Directors and Faculty are qualified to teach students at the appropriate level and have the right to advise a student if they feel the student is not ready for a certain level. I understand that every effort has been made to place students at the appropriate level for their abilities.

Yes, I understand.

I understand that the student may be touched appropriately by the teacher in order to achieve a certain position of the body as it pertains to the dance form.

Yes, I understand.

Every parent/guardian is responsible for the student before class time and once the student leaves the studio in which dance class has taken place. The teacher will only release the student to a parent or guardian known to be a responsible party for the student.

Yes, I understand.

I certify the student has no health issues which could impact or interfere with their ability to safely participate in dance class. If there is a health issue, I will notify the directors of the problem.

Yes, I understand.

Electronic Signature

I hereby declare all of the above to be true to my knowledge. I understand all of the policies above and sign my name below as a legal guardian of the student.

Date

YYYY

Anything additional you feel we should know? Please list any allergies here.

Mini Dance Camp Registration Form

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