Melindas

Dance Studio 2015 Summer Camp Registration Form

*Note each camp must have a minimum of 8 dancers and could be cancelled the week prior to
camp if this is not met. Limit 15 dancers per camp. Registration Deadline: MAY 11th!

Class Theme

Age

Date

Time

Price

Check Camp Here

Superhero Camp

Kindergarten

June 15 18

9:30 11:30 am

$40

Superhero Camp

1st-2nd Grade

June 15 18

12:30 2:30 pm

$40

Turns, Jumps, Leaps!

5th-6th Grade

June 15 18

6:00 7:00 pm

$20

A Bugs Life

3-4 Years Old

June 22 25

9:30 11:30 am

$40

Hawaiian Luau

3rd-4th Grade

June 22 25

12:30 2:30 pm

$40

Turns, Jumps, Leaps!

7th-8th Grade

June 22 25

6:00 7:00 pm

$20

Its A Beach Party!

Kindergarten

July 6 9

9:30 11:30 am

$40

Pirates & Treasure Hunters

1st-2nd Grade

July 6 9

12:30 2:30 pm

$40

Flexibility & Technique

5th-6th Grade

July 6 9

6:00 7:00 pm

$20

Once Upon A Time

3-4 Years Old

July 20 23

9:30 11:30 am

$40

Pirates & Treasure Hunters

3rd-4th Grade

July 20 23

12:30 2:30 pm

$40

Flexibility & Technique

7th-8th Grade

July 27 30

6:00 7:00 pm

$20

Childs Name

Grade (Next Year)

Birthdate

Age

Currently MDS Student? Yes No ANY FOOD ALLERGIES

Parent/Guardian Name

Address

Email

Phone

Emergency Contact Name & Number

I give permission for my child to participate in MDS Summer Camp. All MDS
instructors/assistants are hereby released from claim or liability for any accident or injury
occurring from the activity. Melindas Dance Studio is not responsible for any lost/stolen
articles. Please label your dancers belongings. Additionally, I give my permission to use any
photos taken for marketing purposes. Names will not be included.
Parent Signature

Check Number

Amount

Date