Registration CLOSED

NO MORE SPOTS - OFFICIALLY CLOSED

WE MAY STILL HAVE SPOTS AVAILABLE

If you wish to see if your daughter/son can still attend Dance Camp 2019... please email director@conservatorydancecamp.com PRIOR to registering below. Any registration below without prior approval (to verify we have spots available) will be turned away on Monday July 15th.

If there are spots available - the registration FEE has INCREASED.

Tiny Tots (Ages 3 - 6)

Dance Camp Registration DEADLINE is June 30th

LATE Registration (if spots are available) will be July 1st - July 5th (with price increase)

Tiny Tots Dance Camp Registration *

Tiny Tots First Name *

Tiny Tots Last Name *

Sex *

Female

Male

BirthDate *

Age on July15th *

T-Shirt Size *

PreSchool/Elementary School Attended for 2018/2019:

Referral:

I am aware camp is: JULY 15th - JULY 17th MON - WED 9am-12pm July 18th THUR 1pm-3pm with the showcase @ 3pm Location for 2019: Tarpon Springs MIDDLE SCHOOL *

I am aware

Well NOW I am aware! :)

Camp Payment Due

Current Total:

$0.00

Parent/Guardian Contact Info

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Home Phone Number *

Email Address *

Additional Email Address

Please email me updates during camp

Mom's First Name *

Mom's Cell Phone *

Mom's Work Phone

Dad's First Name *

Dad's Cell Phone

Dad's Work Phone

Emergency Contact Info

Emergency Contact #1 if Parent's Can NOT be reached: *

Relationship *

Phone Number *

Alternate Phone Number

Emergency Contact #2 if #1 can NOT be reached: *

Relationship *

Phone Number *

Alternate Phone Number

List ONLY the authorized people to pick up and drop off your child during the week of camp (separate by line and please re-list anyone entered above, including parents): *

Medical Info

My child has no known allergies

TRUE

My child is potty trained *

TRUE

FALSE- We only accept fully potty trained "Tiny Tots"

My child has allergies to the following foods:

This causes anaphylaxis

Y

N

Describe reaction if food is eaten and what is done to manage it:

My child has allergies to the following drugs:

This causes anaphylaxis

Y

N

Please provide supportive health information about any chronic health condition, your concerns, and what we can/show should do:

My child is on the following medication(s):

The Conservatory fo the Arts DANCE CAMP staff will NOT administer medication, except in an emergency situation and/or we have explicit permission from parents.

What else would you like us to know about your child's health/beahvior and well-being?

LEGAL

I understand that the Conservatory for the Arts DANCE CAMP does not provide insurance. I also understand that children with reoccuring behavioral problems will be dismissed from camp without a refund. Misconduct will not be tolerated.

Last date for full refunds is June 30th, 2019. After June 30th, 2019, 60% of all fees are non-refundable. On and after July 15th, 2019, all funds are non-refundable. Please sign below to verify your knowledge of the above refund policy and that all of your information as well as your child's concerning their information, emergency contacts and medical history are correct and to the best of your knowledge.

Parent Initials acknowledging the above two (2) statements *

I, on behalf of myself, and the below named child (“Participant”) (collectively, the “Consentee”) acknowledge that as a participant in the CONSERVATORY FOR THE ARTS DANCE CAMP (the “Program”) that the Participant may engage in, among other things, recreational activities and dance activities. Consentee agrees to assume all risks and liabilities associated with Participant’s participation in the Program and to hold the Conservatory for the Arts DANCE CAMP, its directors, officers, agents, contractors and employees (collectively, “Conservatory for the Arts DANCE CAMP”) harmless from any and all claims, causes of action, losses or damages arising from or as a result of Participant’s participation in the Program, except due to the negligence or wrongful act or omission of the Conservatory for the Arts DANCE CAMP. However, the Conservatory for the Arts DANCE CAMP’s liability hereunder is subject to the extent and limitations of Section 768.28, Florida Statutes, and nothing herein shall be construed as a waiver of the Conservatory for the Arts DANCE CAMP’s sovereign immunity beyond that provided in Section 768.28, Florida Statutes.

Consentee also hereby authorizes the Conservatory for the Arts DANCE CAMP to photograph, record, tape, film or electronically capture in permanent form the Participant and Participant’s name, likeness, image, voice, biographical and personal information, appearance and/or performance, and/or further to use and publish the writings of Participant (collectively, the “Work”).

Consentee further grants the Conservatory for the Arts DANCE CAMP full permission to edit the original Work as shall be deemed necessary; that the Work and Participant’s name may be used, published and distributed, without remuneration to Consentee in whole or in part, for educational, instructional, advertising or promotional purposes in print or over open broadcast, cable, audio-visual, radio, closed circuit exhibition, computer link, Internet or other medium as deemed appropriate by the Conservatory for the Arts DANCE CAMP, in perpetuity, throughout the world. For these purposes, Consentee waives and relinquishes my rights and the rights of the Participant with respect to any personal rights, privacy rights and protections, including, but not limited to, those rights under the Family Educational Rights and Privacy Act of 1974, as Amended (FERPA), Section 1002.21 and 1002.22, Fla. Stat., Section 23 of Article I of the Florida Constitution and The Board of Trustees Conservatory for the Arts DANCE CAMP. Said Work shall become the sole property of Conservatory for the Arts DANCE CAMP and may be copyrighted in its own name or name of its choosing.

Consentee also releases the Conservatory for the Arts DANCE CAMP from any and all claims for libel, slander, invasion of privacy or other claims based on Participant’s appearance and/or performance and the recording of such, and agrees to hold the Conservatory for the Arts DANCE CAMP harmless from any and all claims by third parties, including any claim based on an allegation of copyright infringement related to Participant’s appearance or performance.

I represent that I am the parent or guardian of the above named minor Participant and have the authority to execute this Conservatory for the Arts DANCE CAMP Consent and Release. I hearby consent to the foregoing on behalf of the above named participant.

Parent Initials acknowledging the above statement *

Please sign here to acknowledge consent and confirmation that all of the information entered above is correct: *

clear

PayPal

The next page requires you to pay through PayPal. Your registration will go through to the staff as soon as you click below, however, you will not be considered officially enrolled until your PayPal transaction is complete. You will receive an email from Conservatory for the Arts Dance Camp as well as PayPal!