BNM Performing Arts Summer Camps 2014

1. BNM Performing Arts Summer Camps 2014 New Student Registration Packet

2. WEEKLY THEMES & DAILY SCHEDULES SCHEDULES ARE SUBJECT TO CHANGE - SWIM ONCE A WEEK!

3. 115 Clairemont Ave.Decatur, GA 30030Summer Dance Camp 2014 Registration Form Dancer’s last name________ Dancer’s first name _______ Street address _______ CityPostal Code _______ Dancer’s birth date_______ Dancer’s age (as of May/2014)______________ Parent 1 Full Name Cell # ______ Parent 2 Full Name Cell # ______ Home phone ( )Emergency phone ( ) ______ How did you hear of BNM Dance Academy of Decatur? ______ _________________ Please list any known allergies ______ ______ Previous dance experience ______ ________________ Child’s T-Shirt Size □ x-small □ small □ medium □large □x-large ________________ FOR OFFICE USE ONLY Method of payment: cashcheck Credit CardMoney Order BNM Dance Academy Summer Intensive: Full-day $115.00/week Half-day $85.00/week Registration Fee $50.00 – Includes camp tee Weeks of Camp______________________________________________________________________________________________________________________________________ Last name on checks):staff initials:date:

4. WHAT TO EXPECT FREQUENTLY ASKED QUESTIONS • How do I register? Registration is a Quick & Easy Process. You may reserve your child’s space in any of our Summer Dance Programs by visiting us online at www.barefootnmotion.com or in the Studio at 115 Clairemont Ave., Decatur, GA 30030 . $50 RESERVES YOUR CHILD’S SPACE! • Registration deadline? Pre-Registration must be completed at the Studio anytime before May 26 . Camp is subject to cancellation if enrollment minimums are not met. Camp will be closed to further enrollment once maximums are met. • What form of payment is accepted? Cash, Money Order, Credit Card or check is accepted. Please make check payable to: Barefoot n Motion. • Who can sign up? Boys and girls ages 5 to 15 can sign up for BNM Performing Arts Summer Programs. Dancers must be fully potty trained. Dancers entering grades 4-12 are invited to register for our Dance Intensive Programs. • What should my dancer wear? Dancers can wear any appropriate clothing that is comfortable and easy to move in. Dance Attire is encouraged. • Are dance shoes required? Dance shoes are required at a minimum your child should have a pair of Jazz or Ballet Shoes. Shoes can be purchased at Payless Shoe source or any of your local Dancewear stores. Flip-flops not permitted. • Is there a performance? Yes, an informal show is scheduled for end of Camp (Friday) of Each week. Campers will have the opportunity to showcase what was learned throughout the week. WHAT TO BRING TO CAMP EVERYDAY • Dance Bag (w, Dance clothes & Shoes) • Hand Towel or Wipes • Bottled Water (2 bottles) • Bagged Lunch (Full Day Dancers) • Suntan Lotion (Fieldtrips) • Change of Clothes • Plastic Bag • 2- Healthy Snacks • Dance Notebook • Comfortable Shoes for after class (OPTIONAL)

5. HEALTH AUTHORIZATION FORM A copy of your child’s Immunization Record MUST be submitted prior to camp. (All forms expire annually) Campers Name___________________________________________________________________ Gender _____________ Birth Date ___________________________ Age ______________ Healthy History Has camper been hospitalized or had operations, serious injuries, fractures, etc. in the past five years? ___ No ___Yes (Give dates and details): ►Does camper have any chronic or recurring illness or conditions? __________________________________________________________________________________ ►Should any activities be limited? __________________________________________________________________________________ ►Current medications(s) (send with instructions) __________________________________________________________________________________ Note: Medications must be checked in at the sign in table. Medications must be in an original prescription bottle. List Allergies: ________________________________________________________________________ Suggestions on health related information for camp personnel __________________________________________________________________________________ This health history is correct as far as I know, and herein described has permission to engage in all prescribed camp activities except as noted. Authorization of treatment: I hereby give permission to the medical personnel selected by the camp director to order x-rays, routine tests, treatment: to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for me/or my child. In the event that I can not be reached in an emergency, I hereby give my permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, for the person named above. The completed forms may be photocopied for trips out of camp. __________________________ ______________ __________________ Signature of parent or guardian Date PARENT’S AUTHORIZATION As the parent/guardian of the camper, I authorize ______________________________ (camper’s name) to attend and participate in all prescribed BNM Dance camp activities. I give permission to the Camp Director and any other designated camp staff to administer first aid and in the event of an emergency, to secure a physician for any medical or surgical treatment needed for my child. I understand that a conscientious effort will be made to locate me before action is taken. I understand and accept that this expense will be my responsibility. I understand that it is my responsibility to carry primary accident insurance. I give my permission for my child to participate in transportation to and from camp site, if attending BNM Dance Camp Full Day programs I give permission that any photos or videos taken of my child can be used for promotional purposes only. ___________________________________________ _________________ Signature of parent or guardian Date

7. BNM Dance Academy of DecaturFull and Half Day ProgramsStatement of Understanding Please initial each statement below and sign at the bottom. ___1. I understand that any changes I make in my child’s camp registration must be in writing to the camp office and that all deposits are non refundable. ___2. Any changes in camp will result in a $10 per camp transfer fee. ___3. I understand that if my balance is not paid at the time of camp or if I am not registered for the week, this will delay or prevent my signing in. ___4. I understand that I / or whoever I have authorized to pick up my child must present a picture ID. ___5. I understand that my child will be participating in at least 4 hours of physical activity each day. ___6. I understand that if I have conflict with another parent, camper or staff, I will conduct myself in an appropriate manner that is a positive example to all our campers. ___7. I understand that my camper is not to bring anything to camp that will be extremely upsetting if it is lost, stolen or broken. ___8. I understand I am to NEVER lay my hands on another camper in an attempt to correct or intimidate. ___9. I understand that if my child is unable to adhere to the rules of the Barefoot n Motion Dance Camp, I may be called upon to pick up my child early. I also understand that some behavior may warrant a suspension and it is up to me and / or my family to accommodate those arrangements. ______________________________ ________________________________ Camper’s Name (print) Parent / Guardian’s Name (print) ______________________________ ________________________________ Date Parent / Guardian’s Signature