Burn the Floor…with the Doerr’s Performing Arts Camp
Registration Form
Camper's
Name_____________________________________________________________________
(last) (first) (middle)
Address
__________________________________________________________________________
City
__________________________________________
State______________
Zip____________
E-mail address
_____________________________________________________________________
Daytime Phone
_____________________________ Evening Phone___________________________
Child's Age (as of August
8th , 2010)___________ Birth
date_______________ Sex_____________
Parent / Guardian
Names_____________________________________________________________
Contact person in
case of emergency ____________________________Relationship_____________
Daytime Phone
_____________________________ Evening Phone__________________________
Address (if
different than camper's) ____________________________________________________
Dance
Experience: Studio Name
______________________________City, State_____________
Please list the subjects taken, number of years, and dance instructor's
name: ____________________
________________________________________________________________________________
________________________________________________________________________________
Acting, Theatre, Drama, Singing Training / Experience:
____________________________________
________________________________________________________________________________
________________________________________________________________________________
Additional information about the participant the camp should be aware
of: _____________________
________________________________________________________________________________
________________________________________________________________________________
How did you hear about Burn the Floor…with the Doerr’s
Performing Arts Camp? ______________
________________________________________________________________________________
Did you attend Burn the Floor Performing Arts Camp last year?_______If so, are you bringing any friends to camp
this year that have never attended before? (Please list names)___________________
_________________________________________________________________________________
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Shirt size (circle
one): Child-L Adult- S
M L XL
(Each camper receives a complimentary shirt)..
Do you have any
roommate requests? ___________________________________________________
Tuition Balance
Enclosed $_________
(Please make checks payable to Sally Doerr)