$145 + hst

___     July 5th – 9th
___      July 12th – 16th
___      July 19th – 23rd

___     Aug 9th – 13th
___      Aug 16th – 20th
___      Aug 23rd – 27th

Name______________________Age________
Health Card # _________________________
Address ____________________________________________
Phone # Day  _____________ Evening ________________
Emergency Contact if no answer
Name _______________________________________________
Phone # ____________________________________________
Relationship _______________________________________

I give permission for my child to attend Dance Pointe’s Dance Camp Program.

Students are responsible for their own Insurance and any loses incurred are not

the responsibility of Dance Pointe.

Parent/Guardian Signature

____________________________________________________