.

Participant’s Name: _________________________________

Age:______ Week 1: _________ Week 2: _______ Both: _________

Bunk Mate Preference: ____________________________________

Parent’s/Guardian’s Name: _____________________________________

Street or Box #: ______________________________________

City/Town: ________________________ Prov.:___________

Postal Code: _________________ Day Phone#: _______________

Evening Phone Number: _________________________________

Health Number: ________________________________________

Name & Phone Number of person to Call in Case of Emergency:
_____________________________________________________

Dance History/Background:_____________________________________

___________________________________________________________

___________________________________________________________

First come, first serve.
Deposits are required to reserve spots. 
Dance camp fees and deposits are non refundable.  
Please forward registration and deposit prior to May 30, 2010.
Costs & Payment::  $480.00
Deposit due with Registration: -$100.00
Balance post dated cheque June 25, 2010 $380.00
Please send both cheques at with registration to reserve your spot.

I wish to pay by: Cheque or Credit Card 
(Make cheque payable to Wade Dance Camp)
 Circle one:    Visa          Mastercard
Credit Card Number: ___________________

Expiry Date: __________________

Name of Cardholder: __________________

Cardholder Signature: ___________________

Photo Consent:
I give Asessipppi Ski Area & Resort and Wade Dance consent to use the photographs taken during camp week for promotional purposes.

Signature:______________________