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Summer Dance Camp
Week 1 July 3-7 Ages 12-16 9:00am-4:00pm
Week 2 July 10-14 Ages 6-11 9:00-4:00pm
Location: Kazka Dance Collective Unit 4-651 Stafford St.
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Participants Name
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Parent/Guardian's email address
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Parent/Guardian Mobile Number
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Which week will your participant be attending?
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Week 1 July 3-7 Ages 12-16
Week 2 July 10-14 Ages 6-11
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Do require early drop off?
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No
Do you require late pick up?
Yes
No
Do you agree to have your participant photographed or filmed for social media purposes?
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Please list any allergies or medical issues
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Emergency Contact (Please list two)
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Manitoba Medical Number (6 digit followed by 9)
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What size t-shirt is your participant?
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Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Other:
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An invoice will be sent once this form is submitted. What would you like your first payment to be?
$100 deposit
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