Participant Polices and Procedures & Application Dance Time, INC Participant Polices and Procedures & Application Participants Name _________________________ Age ____________ Address ____________________________________________________________ City ______________________ State _______ Zip ___________ Home Number ___________________ Fax Number ________________ Parent _________________________ Work Number ______________ Parent _________________________ Work Number ______________ E-mail _____________________________________________________________ School Name ________________________ City ______________ State ________ How did you hear about us? ___ flyer ___ Internet ___ friend ___ brochure T-Shirt size: Youth S M L or Adult S M L Medications _________________________________________________________ Please Review the following Polices and Procedures and sign below. Must wear tennis/dance shoes at all times Must be signed in at registration and out at dismissal by a parent Please label all personal items with your child’s first and last name All participants must be picked up no later than 15 minutes after dismissal by the person/persons designated on the insurance waiver. All participants are required to be team players, disrespectful behavior, bullying, fighting, or teasing will not be tolerated. I agree to adhere to the above mentioned policies and procedures. Participant Name_____________________ __________________ ___________ Parent Signature Date Payments: Please check the following payment option that applies. We accept Certified Checks and Money Orders only Mail to: 170 Cinnamon Oak Circle Covington, GA 30016 Dance Experience ____ Jazz _____ Hip Hop ____ Ballet _____ Lyrical ____ African _____ Other Have you received any previous dance training? If so, where? _________________________________________________________________________________________________________ *Please be advised that although instructors are contracted to teach at this camp, in the event that an instructor has an emergency and can’t make it, a replacement will be provided.*