Summer Program Registration

"*" indicates required fields

Summer Programs*

Holiday Summer Camp

Summer Class - Preschool

Summer Class - Mini Hip Hop

Mini Jazz

Junior Hip Hop

Junior Jazz

Senior Hip Hop

Senior Conditioning

Summer Hip Hop Intensive

Student Name*

Parent's Email Address*

Phone #*

Student Age*

Parent Name*

Emergency Contact*

Allergies / Health Concerns

Billing Address*

Street Address Address Line 2 City Province Postal Code

Total

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Credit Card*

Card Details

Cardholder Name