Fitness411 Productions

PARTICIPANT INFORMATION
Camp Date
Full Name *
Gender
Address *
City *
State *
Zip Code *
Home Phone *
School *
Grade *
PARENT INFORMATION
Mother
Cell Phone
Work Phone
Father
Cell Phone
Work Phone
E-Mail *
Emergency Contact Name*
Emergency Phone*
Relationship*
	How did you hear about the Dance2Fitness Camp?
	(Check all that apply) Allergies Hay Fever Poison Ivy Etc Insect Bites / Stings Pencillin Other Drugs Asthma Frequent Ear Infections Heart Defect Diseases Diabetes Bleeding / Clotting Disorder Hypertension Mononucleosis Chicken Pox Measles German Measles Mumps
	Date of Last Physical and result?
	Any Allergies? How Serious? Medications?
	Any Chronic Illness/medical Condition?
	Taking Any Current Medications?
	Physical Limitations/Handicaps?
	Other conditions that would help us in working with your child?
Shirt Size
	Must register by June 14th for guaranteed shirt.

For more information on Dance2Fitness click here. If you have a general question please see our frequently asked questions page.