Sizzlin' Summer Programs Registration

Summer Camps Registration

Summer Camp Registration*
Price: $150.00
*Payment, Taxes and Fees due at the time of registration
Program
Taxes and Fees
Price: $0.00
Dancer's Name*
First Last
Male/Female*
Birthdate*
Date Format: MM slash DD slash YYYY
Medical Conditions/Allergies
Guardian's Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Email*
Payment Method*
- Credit Card
- eCheck - ACH
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
eCheck - ACH
Name on Account Bank Name Routing Number Account Number Account Type
Total
$0.00
Including Taxes and Fees
RELEASE FORM AND WAIVER OF LIABILITY*
I, the undersigned parent or legal guardian of the dancer(s) listed above, do hereby give permission for the aforementioned persons to participate in any and all classes, programs, shows and events offered by or attended by Debut Dance. I accept all risks associated with that participation and understand that there is the full possibility of serious physical illness or injury. I hereby covenant not to sue and waive, release and forever discharge any and all rights and claims for damages, which may arise now or in the future against Debut Dance and its officers, owners, directors, employees and/or other representatives or volunteers from any and all liability and for any and all damages and./or injuries which may be sustained or suffered by the dancer(s) listed above while participating at or for Debut Dance. Furthermore, I hereby give my permission to Debut Dance to use photographs and/or videos of the dancer(s) listed above as deemed appropriate for the promotion Debut Dance.
- Yes