Camper's Name

Address

Address (cont.)

City

Province

Postal Code

Camper's Birth Date:

Month/Day/Year

Home Phone

Work Phone

E-mail

Emergency Contact Name & Number

Emergency Contact Name Emergency Contact Number

Camper’s allergies/medications/other health information:

PLEASE CHECK OFF  - I am registering the camper for the following camp(s):

Dancin’ & Jammin’. Petite Dancers. Ages 3-4 years. July 19-23. 10:30 am- noon. $60 + GST

 

Dancin’ & Jammin’. Mini Dancers. Ages 5-7 years. Aug 23-27. 1-4 pm. $100 + GST

        

Music Video Mania. Ages 8-12 years. Aug 23-Aug 27. 9 am-4 pm. $200 + GST

    

Dance Leadership Camp. Ages 11-15. July 19-23. 9 am – 4 pm. $200 + GST

     


DISCOUNTS APPLIED

 

I have subtracted from the tuition the following discount(s) for which I am eligible:

 

10% for early registration (form & payment received by Sam’s Steps by MAY 31 2010)

 

10% for family discount (2 or more campers from the same family)

        

10% for multiple camps for a single dancer (family discount does not apply)


 TOTAL TUITION INCLUDING DISCOUNTS: + 5% GST =


Please note: Sam’s Steps Dance Centre will pay the provincial portion of the HST where applicable.  Tuition is non-refundable without a doctor’s certificate.

PAYMENT METHOD

I have paid online by Paypal (see Pay Online menu button) & mailed in reg. form
I have mailed my check to Sam’s Steps Dance Centre with my reg. form
I will pay in person at the SSDC & drop off my reg. form

* I give SSDC the permission to take photographs of the camper

listed above for promotional use or on our website:                             Yes    No  


Parents Signature/Guardian Signature:

__________________________

Date

__________________________
Month/Day/Year