Mirror Image Dance Company Summer Camp Registration Form 2022
Please fill out ONE form PER Dancer
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Email *
Dancer Name - First AND Last *
Dancer Birthday *
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YYYY
Dancer Cell Phone (000) 000 - 0000 (Type N/A if Dancer doesn't have a cell phone.) *
Dancer Email (Type N/A if Dancer doesn't have an email) *
Select your shirt size *
Parent/Guardian #1 - Name: First AND Last *
Parent/Guardian #1 - Cell Number *
Parent/Guardian #1 Email *
Parent/Guardian #2 - Name: First AND Last *
Parent/Guardian #2 - Cell Number *
Parent/Guardian #2 Email *
Please select the dance camps(s) that you want to register for: *
Required
By typing your first and last name below, you understand that an invoice will be sent to the email listed above for the $50 non-refundable deposit per camp. You will have 5 days to complete the transaction to save your dancer's spot. *
Does your dancer have any allergies? If yes, please explain. If no, then write None. *
First AND Last name of the person we contact in case of an emergency. *
Phone number of the person we call in case of an emergency. *
A copy of your responses will be emailed to the address you provided.
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