Music n' Motion Productions - CAMP REGISTRATION FORM

2010 Music 'n Motion - CAMP REGISTRATION FORM

CONTACT INFORMATION
Name
Age
Sex		M F
School
Grade
Years on Team
Address
City, State Zip
Phone
Email
CAMP INFORMATION - Pick three of the following classes
Choose 3 classes from the list below (only 3, please!) * Elite Classes offered only at Elite Camps
FLAG CLASSES Beginner Intermediate Advanced Elite *
RIFLE CLASSES Beginner Intermediate Advanced Elite *
SABRE CLASSES Beginner Intermediate Advanced Elite *
JAZZ CLASSES Beginner Intermediate Advanced Elite *
LYRICAL/CONTEMP. CLASSES Beginner Intermediate Advanced Elite *
HIPHOP CLASSES Beginner Intermediate Advanced Elite *
I WILL ATTEND THE FOLLOWING CAMP
I CHOOSE THE FOLLOWING OPTION ON MY CAMPER STATUS
DAY CAMPERS $109 INSTRUCTION ONLY	DAY CAMPERS W / MEALS $149 INSTRUCTION, PLUS 2 LUNCHES, 2 DINNERS, CAMP T-SHIRT AND LANYARD		OVERNIGHT CAMPERS $249 INSTRUCTION 2 LUNCHES, 2 DINNERS, T-SHIRT AND LANYARD. PLUS 2 HOT BREAKFASTS, HOTEL STAY AND LOCAL TRANSPORTATION
$39 CAMP T-SHIRT & LUNCH (Only for HARDEE HIGH SCHOOL CAMP)
SELECT T-SHIRT SIZE	S - M - L - XL - XXL
SPONSORS ARE ENCOURAGED TO ATTEND CLASSES AND WELCOME TO ATTEND FREE AS DAY CAMPERSOR ADD MEAL COSTS ($40) OR OVERNIGHT COSTS ($179) AS CHAPERONES. TEAMS OF OVER 10 RECEIVE A $10 DOLLAR PER MEMBER DISCOUNT WHEN PAID WITH A SCHOOLCHECK BY OUR DEADLINE OF JUNE 1ST. A $50 NON-REFUNDABLE DEPOSIT IS REQUIRED WITH EACH REGISTRATION.
MEDICAL INFORMATION
Health Insurance Company
Policy Number
Group Number
Emergency Contact
Phone
Current Medications, Allergies
CONSENT
I give my child permission to attend and participate in the Music 'n Motion Performance Camp and release the director and instructors from all liability in case of accident. I hereby authorize Music 'n Motion to authorize and obtain medical treatment for my child named above in this registration form.
Agreement		Click here to agree with the above statement.
Submission