South Albany Southern Belles Dance Clinic Ages 3 High School

Saturday, May 12, 2012 9:00 A.M. 2:00 PM *** in the SAHS Gym

Late Registration and check-in 8:30 9:00 AM

$25

includes a t-shirt!

(with pre-registration only)

***All dancers will perform for family and friends starting at 1:00 PM
WHAT TO BRING: a sack lunch and a water bottle. WHAT TO WEAR: dance shoes or tennis shoes, dance clothes or sweat pants, and a t-shirt.
FOR MORE INFORMATION: call Ashley at 541-990-2194 or SAHS 541-967-4522 or email

custisa@live.com ****************************************************************************
FILL OUT THE FORM BELOW, DETACH IT, AND RETURN IT WITH PAYMENT to South Albany High School, 3705 Columbus St. SE, Albany, OR 97322. Make checks payable to Southern Belles. The registration deadline is April 27, 2012 in order to ensure a t-shirt the day of the clinic. Registrations after April 27, 2012 should be made at the door. Limited quantities and sizes of late registration t-shirts may be available for purchase at the door the day of the dance clinic.

T-SHIRT SIZE: CHILD S M L or ADULT S

Childs Name Grade circle one

Parent/Guardian Signature

Parent/Guardian Cell

Parent/Guardian Home

Parent/Guardian Work

Mailing Address EMERGENCY CONTACT INFORMATION: Name

Email Address

Relationship to child

Cell

Home

Work Plan/Group #:

MEDICAL INFORMATION: Medical Insurance Co.: Family Doctor: Phone:

I want my son/daughter to have the privilege of participating in athletics/camps at South Albany High School. He/she has my permission to participate in those activities approved by the Greater Albany Public School District and/or South Albany High School. While I expect school employees and authorities to exercise reasonable precautions to prevent injuries, I understand that they assume no financial obligations for injuries that might occur and carry no insurance coverage for student medical care. I also understand that students are responsible for all player equipment owned and issued by the school and will assume the financial burden for any lost or destroyed items.