Form

Students Name:

First NameLast Name

Birth Date

MonthDayYear

Parent or Guardian Name:

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail

Phone Number

Area CodePhone Number

Emergency Phone

Area CodePhone Number

6 Week Class Selections

Camp Selections

FOR PARENT/GUARDIAN (of student under 18 years of age) or participating student (over 18):

Please read waiver carefully then sign below. Signed waiver is required before attending camp.

I hereby voluntarily enroll for dance courses, camps, workshops and related activities (rehearsals, performances inclusives) sponsored by DANCE QUEST INTERNATIONAL, INC.

By enrolling, I hereby agree to participate in these activities with the full knowledge that they involve physical stamina, aerobic activity and other unusual physical demands on the body, and that the risk of physical injury is inherent in any participation in dance and related activities. I assume and understand the risk associated with such activities and/or classes.

Further, I realize and understand that I assume full responsibility hereafter for any medical expenses arising as a result of any such injury resulting from, or associated, with my participation in these activities. I hereby consent and give permission for the above-named (Participant) to receive emergency care if necessary, and agree to take responsibility for all cost incurred.

Therefore, with the full knowledge and appreciation of the risks involved, and in order to allow my participation in classes and related activities with DANCE QUEST, I hereby release and hold harmless DANCE QUEST, its agents, staff, officers, trustees, owners, representatives, chaperones and faculty from all claims, responsibilities, or demands of any nature, including injuries or damage resulting from my participation in the aforementioned dance classes or related activities. SIGNATURE REQUIRED TO ENROLL (Adult, Parent, or Guardian, if under 18).

By Signing below, I give permission for use of photos, videos, Film or other media which may include the participant named above for use in promotional media such as our website, newspapers, magazines, television broachers, flyers or other materials used to inform or advertise the activities of DANCE QUEST. I understand that such media involvement carries no payment or compensation, nor any cost to the participant, student or guardian.

By registering online you are agreeing to the Liability Waiver. Media Release, Policies, and Conditions as stated above. Enter your name to indicate that you have read and understand the terms above. Using this online tool is as legally binding as signing our paper registration form.

First NameLast Name

My Products

6 Weeks Summer Classes $68.00

Quantity

Camp Deposit $50.00

Quantity

Princess Dance Camp (Includes Deposit)$140.00

Quantity

Soul Surfer Dance Camp (Includes Deposit)$140.00

Quantity

American Girl Dance Camp (Includes Deposit) $140.00

Quantity

2012 Dance Quest Company Camp (Includes Deposit)$140.00

Quantity

Glamour, Giggles, and Girlz (Includes Deposit) $140.00

Quantity

Skills and Drills (Includes Deposit)$150.00

Quantity

Summer Experience Registration

Dance Quest Liability Waiver and Media Release

Credit/Debit Card Payment

Select your camp(s) from the list below, then click the "Submit" button. You will be re-directed to the secure payment window. In order to reserve your child's spot a deposit is required per camp. Your camp balance must be paid prior to or on the 1st day of each camp.

My Products