Prima Summer Registration Form

Prima Summer Registration Form Amount Due:___________Check #____________

Student Name_________________________________________________________

Birthdate__________________Current age____________Grade of student in Fall ’17__________________________

Class(es), Camps or Intensives & Times Registering for (i.e Royal Tea, 11-12:30pm)_____________________________ _______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

Address_____________________________________City______________________Zip Code___________________

Parent/Guardian Name(s)__________________________________________________________________________

Phone Numbers: cell_____________________home_______________________work_________________________

Emergency Contact_______________________________________________________________________________

I give _________________________________ permission to participate in dance at Prima School of Dancing and release Prima School of

Dancing and the instructors of the classes from all liabilities. I acknowledge that payment is due at time of registration for guaranteed placement.

Parent/ Guardian Signature___________________________________________________ Date________________________

*An extra registration form included for multiple family members or for a friend who may be interested in Prima’s summer dance programs. Additional registration forms will be available at Prima or on www.primadancing.com.

Prima Summer Registration Form Amount Due:___________Check #____________

Student Name_________________________________________________________

Birthdate__________________Current age____________Grade of student in Fall ‘17__________________________

Class(es), Camps or Intensives & Times Registering for (i.e Royal Tea, 11-12:30pm)_____________________________ _______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

Address_____________________________________City______________________Zip Code___________________

Parent/Guardian Name(s)__________________________________________________________________________

Phone Numbers: cell_____________________home_______________________work_________________________

Emergency Contact_______________________________________________________________________________

I give _________________________________ permission to participate in dance at Prima School of Dancing and release Prima School of

Dancing and the instructors of the classes from all liabilities. I acknowledge that payment is due at time of registration for guaranteed placement.

Parent/ Guardian Signature___________________________________________________ Date________________________

*An extra registration form included for multiple family members or for a friend who may be interested in Prima’s summer dance programs. Additional registration forms will be available at Prima or on www.primadancing.com.