2025 SUMMER PROGRAM POLICIES 2024/25 INJURY AND MEDIA WAIVERS SUMMER 2025 REGISTRATION FORM Parent/Guardian #1 Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Parent/Guardian #2 Name First Name Last Name Email Phone (###) ### #### Emergency Contact Name * First Name Last Name Relationship to Dancer(s) * Phone * (###) ### #### Dancer #1 Name * First Name Last Name Date of Birth * MM DD YYYY Previous Dance Experience Allergies, Medications, Important Information etc. Choose Summer Programs Summer Sampler Dance Camp Level One Summer Sampler Dance Camp Level Two Royal Dance Camp Acro Intensive Level One Acro Intensive Level Two Technique Bootcamp Level One Technique Bootcamp Level Two Summer Tech Classes - Drop In Summer Tech Classes - 4 Week Pass (Unlimited Classes) Summer Tech Classes - Drop In Indicate which date and class(es) you will be attending: Dancer #2 Name First Name Last Name Date of Birth MM DD YYYY Allergies, Medications, Important Information etc. Previous Dance Experience Choose Summer Programs Summer Sampler Dance Camp Level One Summer Sampler Dance Camp Level Two Royal Dance Camp Acro Intensive Level One Acro Intensive Level Two Technique Bootcamp Level One Technique Bootcamp Level Two Summer Tech Classes - Drop In Summer Tech Classes - 4 Week Pass (Unlimited Classes) Summer Tech Classes - Drop In Indicate which date and class(es) you will be attending: Choose Payment Method * Pre-Authorized Debit Credit Card (incurs 3.8% processing fee) Post-Dated Cheque (made out to VIREO) Funding (JumpStart, KidSport, school organization, etc.) e-Transfer to vireodance@gmail.com I HAVE READ AND AGREE TO THE SPORTS INJURY WAIVER * I AGREE I HAVE READ AND AGREE TO THE SOCIAL MEDIA WAIVER * I AGREE I HAVE READ AND AGREE TO THE 2025 SUMMER PROGRAM POLICIES * I AGREE Thank you for your Summer 2025 registration. We can’t wait to dance with you!
