Name: Virtual Dance Palace Camp
Start: 2020-06-15T09:00:00-07:00
End: 2020-06-15T11:30:00-07:00
Location: Online via Zoom

Register

You may use this form to register for any or all weeks of camp.
Scholarships are available for those who need them. We know that circumstances have changed for many families so this year we will be providing scholarships based on an honor system. This means that if your family needs a scholarship, just let us know. Our priority is to make it possible for all interested children to attend. To request a scholarship for camp, please check the scholarship box below and pay the $20 deposit. If the deposit presents a hardship, please do not fill out this form but contact the Dance Palace directly at info@dancepalace.org.
Spanish Level
Please indicate your level

Assistant Leader's Full Name*

Birth Date*

Age*

(Edad)

Grade Completed*

Parent 1/Guardian Name*

Parent 2/Guardian Name*

If none, please fill in 'none' above.

Email*

Phone*

Address*

Summer Address (if different)

Name*

Phone Number*

Emergency Contact Name*

Phone*

Select Weeks*

Session 1: June 21 - 24 (4 days)

Session 2: June 28 - July 1 (4 days)

Session 3: July 6 - 8 (3 days) Teens/tweens only

Session 4: July 12 - 15 (4 days)

Please list relevant health concerns. In case of medical emergency, we will call to inform the parent/guardian and, in the case that we are unable to reach the designated adult, we will call emergency medical services:

Please list relevant health concerns, and prescription drugs including asthma or allergy medication:*

Also, please list emotional, physical, family, language, and behavioral issues that we should be aware of. This information is strictly confidential but will be helpful in working with your camper:*

When your child is having a hard time, how does it manifest?*

Anything we should know that is helpful in supporting your child's participation in online activities?*

Pay*

Full Summer (4 weeks) $1400

Session 1: June 21 - 24 (4 days) $425

Session 2: June 28 - July 1 (4 days) $425

Session 3: July 6 - 8 (3 days, Teens/tweens only) $375

Session 4: July 12 - 15 (4 days) $425

I wish to request a scholarship and will pay a $50 non-refundable deposit.

I have read the release form and will return a signed copy of the pdf to the Dance Palace*

Click to Read the Release Form

Already registered?

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