Summer Dance Camp 2006
Registration Form                                                                                                          
Student Name Age Birth Date

Address City Zip Code

Phone: Daytime: Evening: Cell:

Academic School: Grade Level:

Previous Training: (Please indicate # of years of study)   Dance   Dance Form

With (School and Teacher/s)


Performing Experience


List any special needs your student may have:

Person Responsible for Tuition Payments:

Name: Relationship: Address is the same as the student:

Address: City: Zip Code:

Parent/Guardian Information

Mother's Name Occupation

Address City Zip Code

Phone: Daytime: Evening: Cell:

Father's Name Occupation

Address City Zip Code

Phone: Daytime: Evening: Cell:

Emergency Contact Information
Person to notify in case of emergency (Only if parent is unavailable)
Relationship to Student:
Phone Numbers: Phone: Daytime: or

Injury Waiver: I, the parent/guardian for the above-named student, understand that the activities involved in the SummerArts Camp rarely do, but could lead to injuries and I do hereby waive, release, absolve, indemnify and hold harmless, Community Arts Advisory Council (CAAC) and Dance Express owners, for any claim arising out of any injury to my child. I further give permission for a CAAC staff member or SummerArts staff member, or other responsible adult to obtain whatever medical treatment necessary to preserve life or limb.

Parent/Guardian Signature ________________________________________Date ______________________

Enrollment Fees
The camp fee is $225.00 for the full two-week camp.
A $25.00, non-refundable deposit is due by July 1, 2006 to hold a place for your student. The deposit amount is then applied to the remainder of the camp fee, which must be paid by July 15, 2006. Call our office at 619-749-5455 if you need special considerations on payments. Make checks payable to:
Community Arts Advisory Council
1440 S. Orange Ave. Spc. 34
El Cajon, CA 92020
Please write your students name on the check, particularly if the last name is different from the person writing the check.

Questionaire
    I heard abour Summer Dance Camp from:

    My main area of interest is:

When you have finished filling out the registration information:
Please print it out and mail it to the Community Arts Advisory Council. Make sure you have included your signature and the date.
Thank you for your interest in our camp for your child. We look forward to meeting you and the opportunity to work with your student.


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