Please provide the following contact information and then print off and mail to Sam's Steps.

1252 King St. E, Kitchener, Ontario N2G 2N6
Name
Street Address
Address (cont.)
City
Province
Postal Code
Work Phone
Home Phone
E-mail

Parent/Guardian name

Student’s Birth Date

 (M/D/Y)

Allergies/medications/other health information:
 
Emergency Contact:

Name

Phone
 

 

Which camp(s) are you registering for? (Please check) 


Dance Camp

 

Ages 3-4 – Mon. Aug. 11th – Fri. Aug. 15th  - 1:30pm-3:00pm - $50.00  

 

Ages 5-7 – Mon. Aug. 11th – Fri. Aug. 15th – 1:00pm-4:00pm - $100.00  

 

Ages 5-7 – Mon. Aug. 18th – Fri. Aug. 22nd – 9:00am-Noon - $100.00  

 

Ages 8-12 – Mon. Aug. 18th – Fri. Aug. 22nd – 9:00am-4:00pm - $200.00  

 

I have paid online by PAYPAL
I have mailed payment, via cheque, to   Sams Steps Dance Centre
I will pay in person at the SSDC office

 

*REGISTRATION FORM MUST BE PRINTED AND MAILED/DELIVERED TO COMPLETE THE PROCESS. 

I give SSDC the permission to take photographs of the student listed above for promotional use or on our website:  Yes 1   No 1  

 

Parents Signature:

 __________________________
.

Date
OFFICE USE:
 
Payment Received:

 

10% Deducted for early registration 

 

(by May 11th)* 

10 % Deducted for Special Family Rate 

(2 family members registered)*