CONTACT INFORMATION
Name
Age
Sex	M F
School
Grade
Years on Team	1 2 3 4 5
Address
City, State Zip
Phone
Email

CAMP INFORMATION
I WILL BE ATTENDING THE MUSIC 'N MOTION SUMMER TOUR FOR INSTRUCTION IN			FLAG RIFLE SABRE DANCE
I WILL ATTEND THE FOLLOWING CAMP			Select a Camp... June 6, 7, 8 - TAVARES HS July 11-12-13 - JEFFERSON HS (Tampa Area) June 13, 14, 15 - WINTER HAVEN HS June 13, 14, 15 - HIDDEN OAKS MS June 20-21-22 - LAKE MARY HS
I CHOOSE THE FOLLOWING OPTION ON MY CAMPER STATUS			Day Camper Instruction Only	$109
			Day Campers w/Meals Instruction, 2 lunches, 2 dinners, & camp t-shirt	$149
			Overnight Campers Instruction, 2 nights lodging, 2 breakfasts, 2 lunches, 2 dinners, & t-shirt	$249
SELECT T-SHIRT SIZE			S - M - L - XL - XXL

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