Meredith College Middle School Dance Intensive :2022
Please complete this form to register your child for the camp.  Total cost for the camp is $350.00. The balance for the camp is due July 15, 2022.
Payment may be made in the form of check or money order made payable to Meredith College Summer Camps
Send to:
Meredith College
Cece Toole
Ledford 208
Attn: Summer Camps
3800 Hillsborough St.
Raleigh, NC 27607

Please indicate your child's name and camp on the "for" line of your check.
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Email *
First and Last Name of student attending the camp *
Rising Grade Level 2022-2023 School Year *
Are you planning to be a part of your school ensemble for this camp? If so, please provide the name of your school.
Student T-Shirt Size *
First and Last Name of Parent/Guardian *
Parent/Guardian Cell Phone Number *
Medical Information: I give permission to Meredith College Officials and staff health professionals to view and maintain my child’s medical records during the program and to share them with medical personnel in case of emergency. *
Any medically prescribed meal plan or dietary restrictions:  Explain if applicable *
Any allergies (food, drugs, plants, insects, etc.):  Please list any allergies *
Any medicine (EpiPen, inhaler, etc.) needed to be brought to camp:  Please list medications if applicable *
Family Physician Name and Phone Number *
PERMISSION FOR EMERGENCY MEDICAL TREATMENT:I am the parent/guardian of the above named child, and give consent for my child to attend and participate in the Meredith College summer camp experiences as a camper.  I understand that my child’s participation will include some physical activity. I acknowledge that injuries may occur as a result from participation in this program, and I assume those risks to the extent allowed by law.  I hereby release and hold harmless Meredith College, its agents and employee from liability in connection with or arising from unavoidable accidents, violations or applicable standards of behavior or rules, and any other cause.  I have completed and signed this form in the event that my child encounters a health emergency requiring hospitalization and/or immediate medical care and treatment during the Program, and in order to prevent dangerous delay in treatment.  
Please provide your signature and date that you completed this form:     *
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