Providence location 2009
Providence Ballet S U M M E R 2009, R E G I S T R A T I O N F O R M
S U M M E R 2009, R E G I S T R A T I O N F O R M
Child’s name_____________________________________DOB_________________________
Parent/Guardian _______________________________________________________________
Address_____________________________________________________________________
City___________________________________State____________Zip___________________
Telephone # __________________ cell # ____________________Emergency #_____________
E-mail (optional) ______________________________________________________________
REGISTERING FOR
Broadway Dance Camp I (July 13-July 17) (9:30-3:00) (10-14 yrs) $220.00_______________________
Intermediate I/II Camp (July 27- Aug. 7, 2 weeks) (9:30-5:00) (12-14 yrs) $600.00_________________
Ballet III Camp (Aug.10 - Aug.14) (10:00-3:00) (8-10 yrs) $200.00_____________________________
Ballet V Camp (Aug.17-Aug.21) (9:30-4:00) (11-13 yrs) $260.00 ______________________________
Minimum enrollments must be met by June 15, 2009.
Tuition, ___________
Less deposit due at signing ($50.00 non-refundable deposit per camp) ___________
Balance, ____________
Payment Method; Check/Cash ONLY check #_________ Cash__________
Disclaimer / Waiver of Liability
The undersigned acknowledges that the participation in dance education involves strenuous physical activity and that Providence Ballet, Inc. and its employees will not be held responsible for injury of any kind as a result of this participation. Also, Providence Ballet, Inc. and its employees will not be responsible for administrating prescription medication. For the common welfare, it is necessary to disclose any conditions, physical or otherwise, that may affect the undersigned and/or other participants
Signature of Parent/Guardian _______________________________date _______________
East Greenwich location 2009
S U M M E R 2009, R E G I S T R A T I O N F O R M
3355 South County Trail
Child’s name_____________________________________DOB_________________________
Parent/Guardian _______________________________________________________________
Address_____________________________________________________________________
City___________________________________State____________Zip___________________
Telephone # __________________ cell # ____________________Emergency #_____________
E-mail _______________________________________________________________________
Ballet III/IV Camp (July 20- July 24) (10:00-3:00) (9-11 yrs) $200.00_________________________
Creative Arts Camp (Aug. 3- Aug. 7) (10:00-12:00) (3-5 yrs) $100.00 ________________________
Creative Arts Camp (Aug. 17-Aug. 21) (10:00-12:00) (3-5 yrs) $100.00 _______________________
Dancing Like Swans (class) (July 13 –Aug.3) (3:30-5:00 Monday’s) 6-8 yrs) $60.00 _____________
Dancing Stories (class) (July 13- Aug.3) (3:30-5:00 Tuesday’s) (3-5 yrs) $60.00 ________________
Minimum enrollments must be met by June 15, 2009
Tuition, ___________
Less deposit due at signing ($50.00 non-refundable deposit) __________
Balance, ____________
Payment Method: Check #_______ Cash_______ Card # __________________________exp. Date _________
Disclaimer / Waiver of Liability
The undersigned acknowledges that the participation in dance education involves strenuous physical activity and that Providence Ballet, Inc. and its employees will not be held responsible for injury of any kind as a result of this participation. Also, Providence Ballet, Inc. and its employees will not be responsible for administrating prescription medication. For the common welfare, it is necessary to disclose any conditions, physical or otherwise, that may affect the undersigned and/or other participants.
Signature of Parent/Guardian __________________________________________Date ________________
