PD DAY CAMPS

FILL OUT THE FOLLOWING FORM TO REGISTER FOR PD DAY CAMPS:

PD Day Camp

FIRST NAME

LAST NAME

DATE OF BIRTH

Year

Month

Day

EMAIL #1

EMAIL #2

PHONE NUMBER #1

RELATIONSHIP TO CAMPER

PHONE NUMBER #2

RELATIONSHIP TO CAMPER

ALLERGIES/MEDICAL CONDITIONS

ADDITIONAL EMERGENCY CONTACT INFORMATION

PD DAYS

Friday Oct 23rd

Options (Choose only 1)

Standard PD DAY $45 + hst ($51.30) 8:30am-4:30pm

Standard with Early drop off/late pick up $50 + hst = ($57) 8am-5pm

Before and after Convention $10 + hst ($11.40)

Payments: EMT to mcsodpayments@gmail.com at time of registration

Signature

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By completing and submitting this form, I understand that Melissa Connick School of Dance (MCSOD) shall not be held responsible for any damage, injury or loss of property to any MCSOD participant or guest. Innappropriate behaviour will not be tolerated and all dancers shall respect all members and property of MCSOD. Information contained on this form will not be shared. By signing this waiver I hereby give permission for me/my childs photo and video to be used for promotional purposes.