Student Name *

First Name

Last Name

Student Date of Birth *

MM

DD

YYYY

Camp Session *

Session 1 - July 21 Hopkins

Session 2 - July 28 Burnsville

Teen Intensive - August 4 Burnsville

Do you need before and after care? *

Before and after care is 8:30-9 am and 4:30-5:00 pm. $100 per camp session.

Yes

No

How would you prefer to pay? *

Zelle

Check

Cash

Parent Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

I agree to the PCDA liability waiver *

Liability Waiver: Safety is always the top priority of students in Phoenix Chinese Dance Academy. However, when attending the classes given by Phoenix Chinese Dance Academy (PCDA), you, a student of the class or the adult parent or guardian of a minor student, understand and acknowledge that you are aware of and assume the risks of serious bodily injury. You recognize your responsibility to ensure that the students participates only in those activities for which they have the required skills, qualifications, training, and physical conditioning. You understand that PCDA shall have no responsibilities to pay for medical treatment and related costs if a said student is injured. 免责申明： 凤凰中国舞蹈学校始终把学生的安全作为教学的最优先考虑。但是，当学生参加舞蹈学校的课程时，您（作为学生本人或未成年学生的监护人）知晓学生参加这样的课程仍然存在身体受伤的风险。您有责任确保学生只参与其技能和身体条件达到安全要求的活动。如果学生受伤，凤凰中国舞蹈学校不能承担由此导致的医疗费用和其它损失。

I agree

Photo and video release *

Photo and video may be taken of your child during class and or performances for marketing purposes.

I agree