Please read the details below carefully before submitting the application:

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

What: Our summer camp program will be available right before we go back to school! This two-week program will introduce new actors to basic acting skills, singing, and choreography for the stage. Our showcase performance will be Sid the Sarsaparilla Kid and the Ballyhoo Belle Gang, written by Alethia Hummel.

Who: Your instructor is Dr. Stephanie Van Hassel. She is a community theatre enthusiast of over 25 years and K-12 certified Theatre teacher in the state of South Carolina. Stephanie has been teaching since 2007 and has volunteered in a variety of different community theatres. We will also have a few camp counselors this year!

When: Summer Camp will run from 8:00 AM- 12:00 Noon August 5-16. Our showcase will be Friday, August 16th at 6:00 PM.

Where: Legacy Dance Academy, 106b Main Street, Laurinburg, NC 28352

Payment: You will receive an invoice to the email address you enter on this form. You can pay with credit card through the invoice or cash on the first day of camp. Tuition for this two week summer camp is $150 per camper. We offer a sibling discount of 10% off. Scholarships are available; please contact if interested.

Email *

Participant's Name *

Mailing Address *

Phone number *

Date of Birth *

Age *

T shirt size (Indicate youth or adult size) *

Parent/Guardian Name *

Parent/Guardian Email (if same as above, write "same") *

Parent/Guardian Phone number (if same as above, write "same") *

Known allergies to food, medication, insect bites, etc: *

Special medical concerns that our staff should know about, such as epilepsy, asthma, diabetes, previous injuries to bones/joints, etc: *

Consent for Image Release: By entering my name below, I am electronically signing and agreeing to the release of my child's image if any photos are taken at theatre class. These photos may be shared with me and on social media for the theatre. (If this is something you are not comfortable with, please type "No consent" below and we will make sure to respect your wishes!) *

By entering your name below, you agree to these Pick Up Policy terms: You may be asked to present photo ID to pick up your child at check-out. Please understand that this is for your child's safety. Parents are required to enter the premises to sign in and out for their child each day. If parents are late picking up their child, they will be charged a fee of $5 per minute they are late after a grace period of 10 minutes. In the space below, enter your name as well as any other adults who are allowed to pick up your child. Include their phone numbers. *

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms