Application for After Camp Dance at Amanda Kupillas Dance
Each day dancers will get to explore a new technique. There are 2 sessions each day. Session one, 3:30-4:30 for dancers entering 1st - 3rd grade, and session two, 4:40-5:50 for dancers entering 4th – 6th grade. These classes will be built for a variety of levels. These classes are geared for dancers to learn and have fun.

Amanda Kupillas After Camp Series
Name of Student *
Name of Parents/Guardian 1 and Phone: *
Name of Parents/Guardian 2 and Phone:
Email *
Address: *
Grade child is entering in the Fall of 2022: *
Which Week are you interested in attending: *
Required
Please let us know if there is anything you would like to let us know about your child before camp starts.
Release: I hereby release Amanda Kupillas and teachers  from all liability, for personal injury, illness, or loss of property while participating in classes. Amanda Kupillas and host (when applicable) will not be responsible for unintentional exposure to COVID-19. I have read and agree with the Amanda Kupillas Dance LLC COVID-19 Policy. *
By checking below, I also give Amanda Kupillas Dance permission to use photographs or videos of the named participant in its promotional/educational materials. *
Checks should be made out to Amanda Kupillas Dance. Mailing Address: 12 Maple Lane, Hastings-on-Hudson, NY 10706 OR Venmo @Amanda-Kupillas-1. No refunds will be given past June 17th. *
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