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Kamp Kinderdance - Round Rock
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Indicates required field
Kamp Selection
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June 5-9
June 12-16
July 10-14
July 17-21
July 24-28
Child Name
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First
Last
Choose One
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Female
Male
Birth Date
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MM/DD/YY
Parent Name
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First
Last
Phone Number
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Email
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Diagnosis
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Please share your child's primary and secondary diagnosis (if applicable)
Medications
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Please list your child's medications including dose and frequency.
Allergies
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Diet
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Please list any special instructions regarding eating or dietary habits
Mobility
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Wheelchair
Walker or walking aid
No assistance needed
Bathroom Independece
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Wears diaper
Indicates need to use the restroom
Uses toilet indepently
Uses toilet with assitance
Needs reminders to use restroom
Behavior Management
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Please share any behavior management techniques used to help or reduce negative behavior.
Social Behavior
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Will play and interact with other
Is tolerant of others, not easily agitated
Shy
Friendly
Will sit quietly to watch a program
I agree to the terms and conditions.
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I agree.
Terms and Conditions: By checking the Terms and Conditions button and clicking on submit, I fully understand that any program such as Kinderdance® and its affiliated programs that involve movement and motion can result in physical injury. I permit my child to participate in Kinderdance® and release Kinderdance® International, its owners, employees, Kinderdance® Franchisees, Instructors and staff from all liability for injury to my child from his/her participation in the program. I agree to allow Kinderdance® International or local Kinderdance® franchisees to use the name and likeness in photographs and/or video of my child for advertising and promotional purposes without compensation to my child or myself. Total kamp payment is due at registration and covers my child's enrollment for the week selected. Refunds will only be given if the kamp is cancelled due to low enrollment. I have read and will abide by the terms and conditions outlined in this document and in other communications listing additional policies or changes in policies.
Additional information
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I'm Ready!
Information gathered above regarding diagnosis, medications, diet and allergies are just for Kinderdance Austin and the staff working the camps. We ask these things in order to ensure a safe and enjoyable camp experience for your child.
Kamp Kinderdance
$110.00
One week of Kamp Kinderdance!
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CONTACT US TODAY TO LEARN MORE!
512-468-7419
WWW.KINDERDANCEAUSTIN.COM
KINDERDANCEAUSTIN76@gmail.com
