BREAKOUT DANCE STUDIO
Summer Camp Request Form
PLEASE CHECK YOUR EMAIL SPAM/JUNK/TRASH FOLDERS
for the information you are requesting from us regarding summer camps in order to complete registration.
*
indicates required
Name:
Email:
Comment:
Email Address
*
Parent/Guardian's First Name
*
Parent/Guardian's Last Name
*
Phone Number
*
Student/Child's First Name
*
Student/Child's age today
*
Student/Child's Birthday (MM/DD/YY))
*
Any health concerns we should know about?
*
This form is does not register your child for camp
I just want more information on summer camps.
I am ready to enroll today. Send me the registration link.
Summer Camp I want to enroll in.
Disney Princess Themed Camp (ages 3-5)
Disney Princess Themed Summer Camp (ages 6-8)
Wicked Themed Summer Camp (Ages 7-9)
