Registration Form

Blue Ridge Dance Camp

Student Name:

Birth Date:

Parents Name (If under 18):

Address:

City:

State:

Zip:

Home Phone

Work Phone:

Registration Fee:

Tuition:

TOTAL ENCLOSED:

Payment Method:

Card Number:

Expiration:

Email:

I recongnize that my attendance and participation may expose me to risk of injury or harm. I accept this risk and agree that Asheville Ballet/Blue Ridge Dance Camp and its staff will not be held responsible should such injury or harm occur.

Signature: