CAMP REGISTRATION

2022 SUMMER CAMP REGISTRATION

Register Online for Summer Camp!
Please complete a separate form for each child.

You may pay camp tuition online by clicking the link below.
Registration is not complete until payment is received.

CAMP TUITION

Student Information

* Indicates required field

Student's Name *

First

Last

Gender *

Nickname or Preferred Name *

Age on August 31, 2022 *

Birthdate *

Grade in Upcoming School Year *

Name of School *

Mailing Address *

City *

State *

Zip Code *

Please list any previous dance training and experience (studio name, location, type of dance, length of study, etc.) *

Parent/Guardian Information

Mother or Guardian's Name *

First

Last

Father's Name *

First

Last

Mother or Guardian's Cell Number *

Father's Cell Number *

Primary Email *

Emergency Information (Name of another person to contact if Parent or Guardian cannot be reached.)

Emergency Contact Name *

First

Last

Relation to Student *

Contact Phone Number *

Medical Information

Doctor's Name *

Insurance Company *

List any allergies or medical conditions that we should be aware of. *

Camps

Tippi-Toes Dance Camp 1 & 2 – Ages 3 & 4 (Must be potty trained and turn 3 by August 31)
Hip-Hop Dance Camp – Ages 9 to 17 (Rising 4th-12th Graders)
Junior Dance Camp – Ages 8 to 11 (Rising 3rd-6th Graders)
Pop Stars & Pirouettes Camp 1 & 2 – Ages 5 to 7 (Rising K-2nd Graders)
Senior Dance Intensive – Ages 11 to 17 (Rising 6th-12 Graders)

Please select the camp your child will attend. *

Hip-Hop Dance Camp - July 11-15 (M-F) Junior Dance Camp - July 11-15 (M-F) Tippi-Toes Dance Camp 2 - July 18-21 (M-Th) Pop Stars & Pirouettes Camp 2 - July 25-29 (M-F) Senior Dance Intensive - July 25-29 (M-F)

Liability Release and Waiver

Liability Release

I hereby give my consent for my minor child’s participation in any and all activities prepared by Blue Ridge Performing Arts Academy (BRPAA) during the selected camp. I assume all risk and hazards incidental to the conduct of the activities and release, absolve, and hold harmless BRPAA and all its respective officers, agents, and representatives from any and all liability for any personal injury or any personal property damage which may occur on the premises before, during, or after camp activities.
In case of injury to said child, I hereby waive all claims against BRPAA, including all instructors and affiliates, all participants, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including dance. Some of these injuries include, but are not limited to, the risk of broken bones, torn ligaments, sprains, paralysis, and even death.

Medical Release

I certify that my minor child is physically able to participate in the selected Blue Ridge Performing Arts Academy summer camp.
My minor child is covered by adequate health insurance to cover any cost of any accident and/or injury that may occur to him/her during BRPAA acting or dance camp. Any costs not covered by insurance will be my responsibility as parent/guardian. I give my consent for my child to receive emergency medical care and/or be transported by ambulance or other conveyance to a doctor or hospital for attention or treatment in the event of a medical emergency.

Photo/Media Release

A designated Photographer will be on site photographing during camp sessions.
I hereby grant permission to Blue Ridge Performing Arts Academy the right to take, use, and publish these photographs and/or video footage for editorial, fundraising, and/or promotional purposes, and in any manner and medium including, but not limited to, web pages, Facebook, Instagram, flyers, posters, etc.
I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown.
I acknowledge and agree that there is to be no financial compensation for said use or publication and hereby release Blue Ridge Performing Arts Academy and persons functioning under its authority from all claims and liability relating to the same.

Agreement of Classroom Protocol

I understand, acknowledge, and accept that due to the nature of dance and acting classes, some touching and/or physical positioning regarding proper body placement may be involved. (At this time, instructors and staff will follow CDC and state guidelines by wearing masks and avoiding all physical contact. Please explain to your child that during this time we are not allowed to give high fives or hugs, which can hurt some children's feelings because they don't fully understand the reason why.)

A Covid Waiver will be sent to your email.

Confirmation

Checkbox *

I, on behalf of my minor child, hereby warrant that I have read this Liability Release and Waiver Form in its entirety and fully understand its contents. By checking this box and typing my name below, I hereby give my minor child permission to participate in any and all activities prepared by Blue Ridge Performing Arts Academy (BRPAA) during the selected camp session. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

Signature *

Date *

Captcha *

I am not a robot.

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