Camp Registration

2024 Summer Camp Registration

* Indicates required field

Parent/Guardian Name(s) *

First

Last

Name *

First

Last

Email *

Phone Number *

Camper Info

Camper #1 Name *

First

Last

Camper #1 Age *

Camper #2 Name *

First

Last

Camper #2 Age *

Camper #3 Name *

First

Last

Camper #3 Age *

Medical and Emergency Info

Please list any allergies/medical conditions that we should be aware of for each dancer... this will be kept confidential. *

Emergency Contact Name (if parents can't be reached) *

First

Last

Emergency Contact Phone Number *

Family Liability Agreement

Heartland Irish Dancers recognizes its obligation to make sure our students and their parents (if student is a minor) are aware of the risks and hazards involved in the sport of dance. By initialing below, I acknowledge that Irish dancing is a voluntary recreational activity that, because of its physical nature, could result in injury. I certify that I do not have (or that my child/student does not have) any health condition that would limit ability to participate in these classes. I release Heartland Irish dancers and all its representatives from all claims on account of any injury which may be sustained by me (or my child/student) while attending any dance class, or event associated with HID. In signing this agreement and waiver, I acknowledge my responsibility in paying for camp fees by the deadline.

Initials *

Family Photo Release

By initialing below, I understand that as a member of Heartland Irish Dancers, any pictures, videos, or other recorded media of me/my child(ren) may be used by HID for the promotion of HID activities and sponsored events.

Initials *

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