Name:  
Age: Male Female
Phone:  
Email:  
Address:  
Town/City:  
Postal Code:  
Dance Studio:  
Personal Health Care#:  
Province:  
Emergency Contact:  
Emergency Phone:  
Roommate Request:  

Please Select One:

Junior Program @ $850.00
Intermediate 1 @ $850.00
Intermediate 2 @ $850.00
Advanced @ $850.00
Accelerated Advanced @ $850.00
 

What size camp shirt would you like? (included in fees):

Child (10-12): Adult sm: Adult med: Adult lg: Adult xl:

Will there be family members on the raft?

Yes No How Many?
*cost per extra person is $30.00 - please include payment with registration

If you want to be a dorm mom then fill out the fields below

Any health concerns we should be aware of:
Would you like to be a dorm mom? Yes No
*Please send an application letter with this registration form. We will notify you with confirmation, as positions for dorm moms are limited.
Your shirt size: S M L XL

Payment

Please complete the payment details so that we may process your registration.
Summer Camp: $ ($850 for the registrant)
Accommodation and Meals $ ($250 for the registrant)
Added rafting participants ($30.00 per guest) $ ($30 per additional guest)