Studio of Ballet Arts

17810 Meeting House Road
Moore Building, Suite 350
Sandy Spring, Maryland 20860

www.studioofballetarts.com

SBA Summer Camp Registration/Release Form

Please fill out the form below to register your child(ren). After submitting the registration, you will be taken to a payment page where you have the option to pay your tuition (the full amount or a deposit) online. You may also pay by check, which must be received at the Studio within five days.

Child 1
Child 2
Child 3
Child 4

First Child ($550 per session)

* First Name

* Last Name

* School

* Grade		* Birthday

* Camp T-shirt included with tuition (check box for size)

Child - Small
Child - Medium
Child - Large
Adult - Small
Adult - Medium

* Sessions Requested

Session 1: June 25 - July 6
Session 2: July 9 - 20
Session 3: July 23 - August 3
Session 4: August 6 - 17

Second Child ($495 per session)

First Name

Last Name

School

Grade		Birthday

Camp T-shirt included with tuition (check box for size)

Child - Small
Child - Medium
Child - Large
Adult - Small
Adult - Medium

Sessions Requested

Session 1: June 25 - July 6
Session 2: July 9 - 20
Session 3: July 23 - August 3
Session 4: August 6 - 17

Third Child ($495 per session)

First Name

Last Name

School

Grade		Birthday

Camp T-shirt included with tuition (check box for size)

Child - Small
Child - Medium
Child - Large
Adult - Small
Adult - Medium

Sessions Requested

Session 1: June 25 - July 6
Session 2: July 9 - 20
Session 3: July 23 - August 3
Session 4: August 6 - 17

Fourth Child ($495 per session)

First Name

Last Name

School

Grade		Birthday

Camp T-shirt included with tuition (check box for size)

Child - Small
Child - Medium
Child - Large
Adult - Small
Adult - Medium

Sessions Requested

Session 1: June 25 - July 6
Session 2: July 9 - 20
Session 3: July 23 - August 3
Session 4: August 6 - 17

Family Information

* Address

* City

* State		* Zip

* Phone

* Email

Mother’s Name

Mother’s Work Phone

Mother’s Cell Phone

Father’s Name

Father’s Work Phone

Father’s Cell Phone

Additional Comments

Medical Conditions

I realize that with any physical activity there is always a risk of accident. I hereby release the Studio of Ballet Arts from any liabilities for injury or damages arising out of personal injury of any kind. I hereby approve my child’s/children’s participation in this dance program and consent to necessary emergency medical treatment for my child/children on my behalf. To the best of my knowledge, there are no physical or other conditions which will interfere with my child’s/children’s participation. I have listed any activity related child’s/children’s diagnosed pre existing medical conditions above.

* required

301-260-2626

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