Registration 2019 PG. 2

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P M S D C 2019
REGISTRATION

* Indicates required field

Dancer's Name *

First

Last

Is the dancer registering as an individual or as a part of a group of 10 OR MORE? *

If registering as part of a group, what is the group's name (church, youth group, etc.)? *

Dancer's Age (How old will the dancer be on July 6?) *

Dancer's Birthday

Month *

Day *

Year *

Please upload Proof of Age for the dancer where her name and birth date are CLEARLY PRINTED. (i.e. birth certificate, medical statement, standardized test results) --- JPG (picture) is the best format. *

Max file size: 20MB

All PMSDC 2019 sessions (meals, biblical instruction, dance instruction) will follow a partnership structure. Since we will be "going to war" as a camp unit this summer, we STRONGLY recommend that every dancer register with a Battle Buddy. Veteran campers should invite someone who has never attended camp. We suggest that every dancer invite a sister, friend, classmate, cousin, or neighbor that they'll be able to go through the week with. Who is your daughter's Battle Buddy? Enter her name so we can connect the girls in our registration files. *

First

Last

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Dancer's Address (Don't miss Praise Movement birthday mail!) *

Line 1

Line 2

City

State

Zip Code

Country

Parent's First Name *

Parent's Last Name *

Parent's Phone Number *

Parent's Email (IMPORTANT camp info will be sent here) *

In case of an emergency DURING CAMP HOURS, who should we contact? (#1) *

Relation to Dancer *

Phone Number *

In case of an emergency DURING CAMP HOURS, who should we contact? (#2) *

Relation to Dancer *

Phone Number *

Besides who's already been listed, please provide names and phone numbers for authorized pick up persons for your child.

Name *

First

Last

Phone Number *

Name *

First

Last

Phone Number *

Dancer's T-Shirt Size *

Youth S Youth M Youth L Adult S Adult M Adult L Adult XL Adult XXL

What pant size (elastic waist) does the dancer normally wear? *

Youth S (Size 2-4) Youth M (Size 6-8) Youth L (Size 10-12) Adult S (Size 2- 4) Adult M (Size 6 -8) Adult L (Size 10-12) Adult XL (Size 14-16) Adult XXL (Size 18-20)

Is there any additional information you'd like to give us concerning the dancer's pant size? *

Does the dancer have any food allergies? *

Yes No

If yes, please explain in detail. *

Does the dancer have any serious illness(es) or medical condition(s) we should know about? *

Yes No

If yes, please explain in detail. *

Specialty Class 1st Choice

Choose Any *

CHEER FLAGS STEP

Specialty Class 2nd Choice

Choose Any *

CHEER FLAGS STEP

Specialty Class 3rd Choice

Choose Any *

CHEER FLAGS STEP

Physical activity can sometimes cause minor mishaps to occur. Therefore, in the event a dancer sustains any injury, illness, or any other physical harm in connection with participation in the Praise Movement School of Dance, Inc. programs, I agree that neither the Praise Movement School of Dance, Inc, nor any of its instructors, employees, agents, or principles shall be liable or responsible for any claims, costs, liabilities, expenses, or judgments (including for example doctor fees, hospital expenses, and personal injury claims resulting from any such injury, illness, or physical harm.) The acknowledgement of risk and waiver of liability, having been read thoroughly and understood completely, is signed voluntarily as to its content and intent. *

Yes No

Praise Movement School of Dance, Inc. believes that the word of God is the final authority by which our lives are governed. Hence, references to the word of God will be used inside and outside of dance instruction to teach Christian living principles and Christ-like behavior. • For dance instruction, Praise Movement School of Dance, Inc. only uses music that uplifts and praises God. The types of music we use are traditional gospel, contemporary Christian, and Christian rap. I have read the above statements, and I understand Praise Movement School of Dance, Inc.’s beliefs and teaching principles. I understand that Praise Movement School of Dance, Inc. is operated by these beliefs and principles and that my child is expected to honor them as long as she is a participant. *

Yes No

I understand that all fees are non-refundable and the sessions may be changed, cancelled, combined, or rescheduled as required. In the event that the dancer registered above decides to discontinue the session, I will inform Praise Movement School of Dance by phone or e-mail, and I understand that I will not receive any refunds. *

Yes No

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P M S D C 2019​REGISTRATION

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P M S D C 2019
REGISTRATION

This form is invalid without payment.
After CLICKING "submit", YOU WILL BE AUTOMATICALLY DIRECTED to the "Submit Payment" page.