SSD Summer Dance Camp Sign Up
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August 8-11
9:00 am - noon
Cheeky Chickadees Ages 5-6
Rockin' Robins Ages 7-9
$175
Little Demo Friday at Noon
Student Name (Last Name, First name)
Student Age & Birthdate (DD/MM/YYYY):
Parent/Guardian Name(s)
Email Address:
Emergency Contact #1 (First & Last Name, Relationship to Student, Daytime Phone Number)
Emergency Contact #2 (First & Last Name, Relationship to Student, Daytime Phone Number)
Please list who is authorized to pick up the student besides parent/guardian(s) & emergency contacts named above (First & Last Name, Relationship to Student)
Does the student have any allergies or medical conditions? 
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