L ambert Dance Company S ummer Mini Dance Camp 2014

1. Lambert Dance CompanySummer Mini Dance Camp 2014 Registration Form Name ________________________________________________________________ Age _______ Grade next year ________ Allergies _____________ Parent(s) Name: ________________________________________________________ Address: _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Home Phone: ____________________ Mom Cell/Work _____________________ Dad Cell/Work ____________________ Emergency Contact Name/Number __________________________________________ Recommended by: ________________________________________________________ T- Shirt Size (Youth ) Circle one: Small Medium Large X-Large Registration is on a come first , first serve basis. The camp is limited to the first 30 participants. Participants must wear appropriate clothing (shorts, T-shirts, etc.) and socks /shoes to camp. Specific dance shoes not required, participants are encouraged to bring them if they have them. Drinks and snacks will be provided daily. Parent permission and Authorization: I hereby, give consent for my child, ________________________________, to attend and participate in the Dance Camp held by the Lambert Dance Company at Lambert High School beginning June 2ndthrough June 6th 2014. If we cannot be reached in the event of an emergency, we also give consent for the school to obtain medical care as deemed necessary should an injury occur during the camp. Name of Insurance Company: ________________________________________________ Policy Number: ________________________________ Parent Signature ___________________________________________ Date _____________ Pease send registration forms and payments to: Checks should be made payable to Lambert H. S. Lambert High School Fee: $80.00 by registration deadline : May 30th Att. Rafael Santiago Walk –in registration $115.00 805 Nichols Road Suwanee, Ga 30024