Revolution Elite Dance Combo Summer Camp 2023 Registration Form
Registration Opens April 14, 2023
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Contact Email *
Contact Phone Number *
Dancers First and Last Name *
Dancer Date of Birth *
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Dancers Age *
Parent First Name *
Parents Last Name *
Emergency Contact Name (OTHER THAN PARENT): *
Emergency Contact - Preferred Phone Number: *
Emergency Contact - Relationship to Student *
PLEASE LIST ANY ALLERGIES, PHYSICAL, MENTAL, OR EMOTIONAL PROBLEMS THE STUDENT MAY HAVE: *
How did you hear about us? *
Waiver and Release Information:  I attest that the above stated physical, mental, and emotional limitations of the student are accurate. I understand that dance and tumbling, sometimes involves extraordinary use of motion. When practicing the art of dance, there are some possibilities for but not limited to the injury of muscle or bones. In consideration for using/ allowing my child/ self, to utilize the facility and staff of Revolution Elite Dance; I hereby forever release the owners, staff, directors, coaches, and all other employees from liability for any injuries suffered by myself or any student in connection with the uses of this facility at 5614 126th  Street. I acknowledge that participation is entirely by choice and I am under no compulsion by Revolution Elite Dance to participate in the programs, nor am I being paid to do so. The interest of myself and my child is solely to participate in the art and his/her self-improvement, and I am willing to accept the inherent risk in this pursuit.  
Please read statements below and checkbox to indicate you agree to all Waiver and Release Information: *
Required
This acknowledgment of risk and waiver having been read thoroughly and understood completely is signed voluntarily as to its intents and contents. Electronic Signature required. *Type First & Last Name in space provided. *
This acknowledgment of risk and waiver having been read thoroughly and understood completely is signed voluntarily as to its intents and contents. Date of Completion. *
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Permission to Administer Emergency Treatment
In my absence, and as a parent or legal guardian of ________________________(student name), I hereby grant my permission, in the event of sickness or injury, to have the necessary treatment administered to my child by a trained professional. *
In addition, I also grant my permission to have my child transported to the hospital, doctor’s office, or an emergency clinic in the event of such injuries or illness *
Electronic Signature of Parent/Guardian Required *
Please indicate the weeks your student will be available for summer classes. SELECT ALL THAT APPLY.   REMINDER - YOUR FULL PAYMENT AMOUNT WILL BE DETERMINED BY WEEKS SELECTED AT REGISTRATION. July classes are due July 11th.  *
Required

Registration and Refunds: Registration for summer camp must be completed online and then we will contact you to set up payment.   $30 registration fee or $50 family registration fee is due at the time of registration to reserve the dancer’s spot as well as a $90 deposit, if you pay in full you will not need to pay the deposit.  Camp is $90 a week. 

 

Recital 2023 dancers’ registration fees will be $20 and $30 for the family. If payments are not received prior to the due date, your registration will be canceledwithout any refund. Payment must be made before the dancer attends class. Your dancer will not be allowed into the classroom if tuition hasn’t been cleared. Camps are non-refundable or transferable. You must sign up one week in advance to come to camp. Each week is themed and we have crafts that go along with the theme and we need to know numbers in advance. 

CLASS INFORMATION:
COMBO AGES 3-9 INFORMATION
Ages 3-9 Tuesday and Thursday 10:00am – 1:00pm
New to RED: Please set up an appointment with Hannah Granville Beasley to finalize summer registration for 2023. Please select the preferred time slot for telephone appointment. Appointment meetings should take no longer than 10 minutes. *
DESIRED PHONE CALL TIME FRAME. *
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