Celebration Street Christian Dance School of the Performing Arts ~ Roseburg, Oregon

Are all studios the same? Click here now to view a studio comparison check list.

Celebration Street Christian School of the Performing Arts
831 Cass St.
P.O. Box 985
Roseburg, OR 97484

(upstairs)

adjacent to Downtown Fitness Center

(541) 679-0752

:: ONLINE DANCE CAMP REGISTRATION FORM ::

Celebration Street Christian School of the Performing Arts

2008 Dance Camp Registration Form

Date:
Choose 1 Camp:	Princess dance camp July 7-11	Princess dance camp July 14-18
	Sock Hop dance camp July 7-11	Sock Hop dance camp July 14-18
Parent's Full Name:
Child's Full Name:		Age:
Prefers to be called:		Date of birth:
Mailing Address:
Home Phone:
Email Address:
School Attending:		Grade:
Church Affiliation:
Dance Education:
Additional Children:	#2	#3
	#4	#5
Emergency Contact:		Phone:
Allergies/Medical Conditions?
	*If you pay the full cost of dance camp, you do not have to pay the $50.00 deposit*
Total cost: $135 per child	Number of children:	x $135.00 =
Non-refundable deposit: $50.00	Number of children:	x $ 50.00 =
Total amount paid:
Balance due:

Photo Release: Celebration Street is hereby granted permission to take photographs and/or videos of the students to use in brochures, website, posters, advertisements and other promotional materials the school creates.

Waiver and Release: I and/or my child hereby agree to participate in dance and exercise programs given by Celebration Street Christian School of the Performing Arts, instructors, employees, and agents (herein collectively called "School") upon the understanding and condition that:

1. I recognize the risks of illness and injury inherent in any exercise or dance program and am participating in the School's program upon the express agreement and understanding that I am hereby waiving and releasing the School from any and all claims, costs, liabilities, expenses or judgments, including attorney's fees and court costs (herein collectively "claims") arising out of our participation in the School's programs or any illness or injury resulting there from, and hereby agree to indemnify and hold harmless the School from and against any and all such Claims proximately caused by the gross negligence or willful misconduct of the School.

2. I hereby execute and deliver this waiver and release to induce the School to permit me to participate in its programs.

I agree to the above Photo Release and Waiver and Release: Yes No

You will be re-directed to our payment page to make your online payment through PayPal.com. Thank you!