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Pam Rossi's Dance Ten 650 Flinn Ave. #6 Moorpark, CA 93021 (805) 529-1958 ____ Mini Camp ____ Dance Camp Dancers Name ____________________________ Age ______ DOB ________________ Parent/Guardian _________________________________________________________ Address ____________________________ City __________________ Zip ________ Phone (Home) __________________________ (Work) __________________________ E-Mail Address __________________________________________________________ Previous Dance Yes ____ No ____ If Yes, Where/ How Long? ________________________________________________ Emergency Contact _______________________________________________________ While participating in any form of physical activities, there are always possibilities of injuries. We at Pam Rossi's Dance Ten stress the proper technique in learning your skills, and professionalism with other peers. If some injury should occur, I, the undersigned, agree not to hold Pam Rossi's Dance Ten or any of their staff responsible. YES, I understand all information. ______________________________________ Parent Signature Office Use Only Class _____________ Day ______________ Time _____________ |