$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
____________________________________________________