2008 SUMMER CAMP Registration Form

CHILD’S NAME:________________________________________________________

AGE:_______________

WEEKS ATTENDING CAMP

_____________________________________________________________________

PARENT’S NAME: ___________________________________________________

ADDRESS: __________________________________________________________

CITY: _______________________________________________ZIP: ____________

PHONE NUMBER: _________________________WORK: ____________________

Email Address: ________________________________________________________

Specify any medical condition(s) we should be aware of:

_______________________________________________________________________

Emergency#: ____________________Relationship:____________________________

WAVIER

I understand that a physician should approve any form of exercise. It is agreed that I waiver and release all rights and claims for damages that I and/or my child might have against Dancers’ Edge, Jana Filling, any of the Dancers’ Edge instructors, or any Dancers’ Edge representative (paid or volunteer); for any injury in connection with the Dancers’ Edge exercise and dance programs or other activities relating to such a program. The risk of such programs is fully understood.

Signed:_________________________________________________________________

(Parent or guardian)

Date:___________________________________________________________________

Registration Fee Enclosed: ________________________________________________

717-285-4982 home business phone

STUDIO LOCATION: MAILING ADDRESS:

Village Plaza Jana Filling

232 Manor Ave. 3855 Columbia Ave.

Millersville, PA 17551 Mountville, PA 17554

SUMMER SCHEDULE

SUMMER 2008 CLASS DESCRIPTIONS

SUMMER CLASS PRICES

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