2005 UI Summer Dance Camp Registration Form

Make Checks Payable and Mail to:

University of Idaho

Center for Dance

PO Box 442401

Moscow, ID 83844-2401

Name:________________________________________

Address:______________________________________

City, State & Zip Code: __________________________

Home Phone: (____) ____________________  email: ____________________________

Dance Experience: _______________________________________________________

______________________________________________________________________

School: _______________________________________

Name of Dance Teacher: __________________________

Year in School (fall 2004) ________

I agree to abide by camp regulations including, but not limited to: No use of alcoholic beverages or nonprescription narcotic drugs; attendance at all campus sessions is required; driving or riding in a private car during the duration is not permitted without the permission of the camp director.  The camp director is authorized to secure medical assistance for any camper requiring emergency treatment during camp.

Student Signature: _________________________________

Parent/Guardian Signature: ___________________________

Payment Enclosed:

___ $25 Nonrefundable deposit (required with application)

___ $140 Tuition before June 1, 2005 (this includes deposit)

___ $165 Tuition after June 1, 2005 (this includes deposit)