ANNEMARIE'S DANCE ACADEMY
Summer Dance Day Camp
-- Mini Camp [Ages 4-6] --

Come to the ADA 2011 Summer Dance Day Camp!
·~º~· Dance Classes ·~º~· Outdoor Activities ·~º~· Arts & Crafts ·~º~· Pizza & Movie Day ·~º~· Local Performance ·~º~·
MINI DANCE CAMP
Ages 4-6:
Hours: 9:00am to 11:30pm
July 18-21, $113 (includes HST)
Register ONLINE here!
You may also register at the office or by phone [519-940-0524]. Please be ready with all the information from this form.

Family Last Name:  
Home Phone #: [Use format 999-999-9999]  
E-Mail Address:
Street Address:
Town:
Postal Code


CHILD #1:
First Name Last Name
Date of birth: YY MM DD Health Card Number
Please check off camp and week(s) child is registering for:
Mini Camp (age 4-6) - July 18-21     
 
CHILD #2:
First Name Last Name
Date of birth: YY MM DD Health Card Number
Please check off camp and week(s) child is registering for:
Mini Camp (age 4-6) - July 18-21     
 
CHILD #3:
First Name Last Name
Date of birth: YY MM DD Health Card Number
Please check off camp and week(s) child is registering for:
Mini Camp (age 4-6) - July 18-21     
 
Mother:
Phone#'s:
 Home (if different):
  		 Work:
  		 Cellular:
  
Father:
Phone#'s:
 Home (if different):
  		 Work:
  		 Cellular:
  
In case of emergency [and parents cannot be reached], please contact:
Annemarie's Dance Academy is not responsible for injuries incurred outside the dance class.


Additional information:


[Please check all information before submitting...]
     
Click this button ONLY ONCE!

THANK YOU!
*** Please drop off current cheque or cash to the studio as soon as possible ***
*** Your child's spot will be reserved when fees are fully paid ***
[No post-dated cheques will be accepted.]

70 Centennial Rd, Unit 1B
Orangeville, ON
L9W 1P9
519-940-0524