Parent Name *

This is the name that your account will be under in our computer system.

First Name

Last Name

Phone 1 *

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Phone 2 *

(###)

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Please check all summer programs you would like to register for. *

More information on each program can be found at misskelleys.com/summer.

Six Week Summer Course - (18 months+, subjects listed below)

Princess Camp (2.5 - 8, June 9th - 12th, $150)

Jazz Team Tryouts (6+, August 4th -9th)

Hip Hop Team Tryouts (9+, August 4th -9th)

Back to Dance "Lock In" (8+, August 1st, $40)

Please check all the SIX WEEK SUMMER COURSE subjects you would like to register for. *

Please check our schedule on our website for class day/times/ages.

None - Princess Camp only.

None - Back to Dance "Lock In" only.

Combo (ballet/jazz and tap, 1 hr, ages 2.5+)

Ballet (1 hr, ages 6+)

Lyrical (1 hr, ages 6+)

Jazz Technique (1hr, ages 6+)

Leaps & Turns (1 hr, ages 6+)

Core Strength & Flexibility (1 hr, ages 6+)

Hip Hop (1 hr, ages 6+)

Musical Theatre (1 hr, ages 8+)

Colorguard (1 hr)

Danceline Prep (1 hr)

Mommy & Me (1 hr, ages 18 mos - 3 yrs)

By checking this box, I am stating that I have read and agree to the terms of this registration. *

If I decide to withdraw my child after registering, I realize that I will continue to be billed until I officially fill out a withdrawal form through the office. As a participant, or parent/guardian of a participant in the program, I acknowledge that there are risks of injury and I agree to assume those risks which I or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with such a program, including traveling to and/or from the activities. I release all claims which may arise against, and agree not to sue Miss Kelley's School of Dance, Inc. and its officers, agents, employees and volunteers from any and all claims by other parties resulting from injuries, damages and losses caused by me or my minor child arising out of, connected with, or in any way associated with the activities of the program. In the event of any emergency, I authorize Miss Kelley's School of Dance, Inc. officials to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my minor child's immediate care and agree that I will be responsible for payment of any and all medical services rendered. I also give Miss Kelley's School of Dance, Inc. permission to use my child's image in its promotional materials and publicity efforts.

I agree.