Summer Session

2025 SATURDSY SUMMER CAMP

3371 Highway 5 Suite B2

Douglasville, GA 30135
THANK YOU FOR YOUR INTEREST IN

CITY STREETS TUMBLING AND TECHNIQUE
INDICATE SESSION*

First NameLast NameAge Grade/ School
NAME :*

First NameLast NameAge Grade/ School
SESSION

JUNE 3RD - JUNE 23RD
Emergency Contact 1*

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Emergency Contact 2*

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E-mail*
If Applicable
Address*

Street Address

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Contact Number*
Dance Experience? Please list type of dance experience. (Example: Hip Hop, Tap, Ballet, Modern, Majorette etc. *
Is your child currently dancing at any dance studios? If so please list dance studio. *
Have your child ever been on a dance team? Please Explain*
Does your child have any medical history and / or allergies that CSDS should be aware of? *
Does your child currently take any medications?*

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Signature*

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Comments*
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Liability Waiver and Acknowledgment of Risk: READ AND SIGN BELOW REGISTRATION IS INCOMPLETE WITHOUT SIGNATURE AND MUST BE COMPLETED BEFORE THE FIRST CLASS I understand and agree that in participating in any dance class, workshop, rehearsal or performance, there is a possibility of physical injury or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me or my child during any of City Streets Dance Studio classes, rehearsals, performances, or activities. I also exempt, release, and indemnify City Streets Dance Studio, LLC its owners, agents, volunteers, assistants, employees, guest artists, faculty members, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with participation in any classes or activities conducted by City Streets Dance Studio LLC. I further hereby voluntarily agree to waive my rights and that of my heirs and assigns to hold City Streets Dance Studio LLC, its owners, agents, instructors, volunteers, assistants, employees, guest artists, faculty members, and/or students liable for such damage, loss, injury, or death. I understand that I should be aware of my physical limitations and agree not to exceed them. If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive these rights. I have read, understood and agree to be bound by the above statement (please print your name, sign & date): PRINTED: SIGNATURE: If under 18, parents or legal guardian must sign FOR: _______________________________(Name of Student) DATED: _________________________________________ *
NAME OF STUDENT

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Date

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Date
Signature

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No Refunds

City Streets Dance Studio *

USDSummer Camp

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

What’s Required for Tumbling & Technique Camp:

All Black Fitted Attire (leotard, shorts, leggings, etc.)

Jazz Shoes (if available)

Hair Pulled Neatly Off the Face

No Phones Allowed During Camp

Positive Attitude is a Must!

Arrive On Time – Late arrivals may not be allowed in

Eat a Healthy Breakfast Before Arrival

Water Provided – Bring a water bottle if preferred

15-Minute Break Between Classes

Please Note: Parents are not allowed to stay due to limited space in the studio.

Let’s work, stretch, and level up this summe!
Should be Empty:

No Refunds

Payment Methods