Dance Camp Registration – LE Dance Studio

Billing Information

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Email *

Parent Contact Information

Parent/Guardian *

First

Last

Relationship *

Mobile Phone *

Work Phone *

Second Guardian

First

Last

Second Guardian's Relationship

Second Guardian's Mobile Phone

Student #1 - Information

Student 1 *

First

Last

Date of Birth *

School *

Grade *

Is student attending in person school this year? *

Yes
No

Has your student had previous dance experience? *

Yes
No

Which dance camp? *

Princess
TikTok
Pop Star

Student #1 - Medical Information

Does your child have any pre-existing health conditions? *

Yes
No

Does your child have a nut allergy? *

Yes
No

Does your child have a condition that will make them unable to wear a mask in class? *

Yes
No

Has your child previously had COVID 19? *

Yes
No

Doctor's Name *

First

Last

Doctor's Phone Number *

Emergency Contact *

First

Last

Emergency Contact Phone *

Hold Harmless Agreement

By selecting the box below, I understand that LE Dance, LLC principles, employees, and volunteers are not liable for any injuries that may occur while my student is involved with participating in LE Dance related classes and events, therefore I hereby release, indemnify and agree to hold harmless LE Dance and its principles, employees and volunteers from any claims or expenses resulting from or arising out of the participation of my student in any such classes or events. LE Dance, LLC is not responsible, whatsoever, for anything that happens before or after the students designated class time. I do hereby verify that I have read and accept the Holds Harmless Agreement, policies, and conditions.

Hold Harmless Agreement *

I agree to the LE Dance Hold Harmless Agreement

COVID-19 Policy

By selecting the box below, I understand that LE Dance, LLC will not allow my child to participate in any classes or activities unless I have completed and signed a COVID-19 waiver (available for download on our website) for my child.

COVID-19 agreement *

I agree to the LE Dance COVID-19 Policy

Image and Likeness Use Agreement

By selecting yes below, I grant permission for LE Dance, LLC its principles, employees and volunteers to use images and video of my child participating in LE Dance classes or activities in order to promote and advertise LE Dance.

Image and Likeness Use *

Yes
No