Camp Registration Form : Chehalem Valley Dance Academy

Select location*

Newberg

Currently there are no camps offered at our McMinnville location.

Dancer Info

Dancer Name*

FirstLast

Gender*

Female
Male

Birthday*

Parent Info

Parent #1 Name*

FirstLast

Parent #1 Phone*

Phone format: (###)###-####

Parent #1 Email*

Parent #2 Name

FirstLast

Parent #2 Phone

Phone format: (###)###-####

Parent #2 Email

Medical

Does your dancer have any medical needs, allergies, or other considerations?*

If you selected anything other than 'no' to the question above, please expand on your answer here

Emergency Contact*

FirstLast

Emergency Contact Phone*

Phone format: (###)###-####

Camps

List camps in date order*

List the camps in this format: Princess Party Camp June 25-28 9-11am and separate camps by line

Are you a Performing Company Dancer?*

Yes
No

If you are a PC dancer, are any of the camps you listed required?

Yes
No
I don't know

Your required camps are listed based on the group that you are in and can be found on the PC requirements page.

Please list your dance experience*

Describe your dancer*

New student
Returning student
Returning student that took a break and is not returning
Adult dancer

Choose the best description for your dancer. If your dancer did not take class in 2011-2012, please select the 3rd option.

How did you hear about us?*

If you selected referral or other in the question above, please explain below

Payment

Payment Options - Per Camp*

In full with registration fee discount
Gift certificate
Half now with registration fee, other half at deadline
Registration fees only (non-refundable)

All dancers pay a $5 nonrefundable registration fee per camp (families pay no more than $15 total) unless registering and paying in full. Checks need to be separate from tuition and we will refund tuition for camps that do not meet their minimum enrollment requirement. We will email you camp tuition totals within 3 - 5 days of your registration. Camp tuition is calculated per the tuition policies.

Do you give CVDA permission to use your dancer's image for marketing and promotional materials?*

Yes, I give permission
No, I do not give permission

I have read and agree to the liability waiver*

Please read and type your full name into the signature line above if you agree to the terms: I agree to release and hold harmless Chehalem Valley Dance Academy, All Star Dancewear, and anyone providing services for Chehalem Valley Dance Academy or All Star Dancewear from any and all claims of any nature, including, but not limited to property lost, personal injury, or death. I agree to release Chehalem Valley Dance Academy from all claims that might occur at their annual showcase or any othe CVDA event my dancer may be participating in. I understand that teachers may physically adjust my dancer's placement. I will not leave my child under the age of 10 unaccompanied in the lobby, in All Star Dancewear, or outside on the benches of CVDA.

BEFORE SUBMITTING

BE SURE TO HAVE FILLED OUT EVERY SELECTION WITH AN ASTERISK OR IT WILL NOT SUBMIT AND YOU WILL HAVE TO ENTER IT ALL YOURSELF AGAIN. THIS FORM DOES NOT REMEMBER INFORMATION.

Camp Registration Form

Camp Registration Info

Please be sure to check the prerequisite for the camps before registering for them.

For questions regarding eligibility for camps, email kristen@iheartcvda.com.

2013 Camp Registration Form

Dancer Info

Parent Info

Medical

Camps

Payment

BEFORE SUBMITTING

Twitter @iheartcvda

CVDA on Facebook