Thank you for helping us get to know your child.

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* 1. Child's Name:

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* 2. Date of Birth (MM/DD/YYYY):

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* 3. Which race/ethnicity best describes your child? (Please choose only one.) *For grant writing purposes only

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* 4. Child's Gender; *For grant writing purposes only

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* 5. Would your child qualify free or reduced lunch? *For grant writing purposes only

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* 6. Does your child have special educational needs? *For grant writing purposes onle

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* 7. Child's School:

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* 8. First Parent or Guardian's Contact Information:

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* 9. Second Parent or Guardian's Contact Information:

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* 10. I do hereby acknowledge and state that said minor is presently under my care, custody and control and that I possess the authority to grant the permission and authorization stated herein, and the minor has no conditions, which would prohibit or restrict her/his participation with Danceworks, Inc.

Off-site trips rarely take place, but on occasion we will walk to a nearby park.
I give my permission for the minor to participate in these supervised walking activities sponsored by said party. 

I authorize any representative of Danceworks, Inc. to consent to and authorize any medical attention, treatment, surgery, or administration of drugs by qualified and licensed medical personnel for my child that become necessary. I understand that I will be notified in the event of an emergency. My insurance company or I will assume all expenses for such treatment.

By filling in name and date, parent or guardian agrees to above statements.

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* 11. This represents my legal signature.

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* 12. Insurance Policy Information:

PICK-UP AUTHORIZATION:

Please list all persons, not including parents, who are authorized to pick-up this child from camp or workshop. The parent/guardian will be called immediately if a person who is not an authorized person attempts to pick up this child. Please notify Danceworks staff both verbally and in writing if someone else is picking up your child.

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* 13. Persons other than parents or legal guardians allowed to pick up child (must be 18 years or older):

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* 14. Is there any person or persons who, legally, are not allowed to pick up or visit your child?

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* 15. Primary Emergency Contact:

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* 16. Secondary Emergency Contact:

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* 17. Child's Medical Contact:

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* 18. List any and all allergies, including medications:

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* 19. List relevant medical information (allergies, nervous disorders, heart trouble, diabetes, epilepsy, etc.):

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* 20. Current immunization status:

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* 21. How does your child interact with new children?

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* 22. How do you describe your child's learning style?

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* 23. What are your child's strengths and weaknesses?

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* 24. What (if any) concerns do you have about your child's day with us? (i.e. self-image, independence, peer relations, behavior, confidence, attitude toward others, etc.)

Please be specific and descriptive. We need your candid input so we can plan accordingly.

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* 25. Is there anything else you would like us to know about your child?

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* 26. I give permission to Danceworks to photograph/video/interview my child for marketing and promotional purposes.

WHAT TO BRING TO A DANCEWORKS SCHOOL DAY OFF CREATIVE ARTS WORKSHOP AND SUMMER CREATIVE ARTS CAMP:

Full day campers should bring a healthy lunch and light snack. All lunches should be packed in a thermal bag/box
with your child’s name clearly marked. You may also wish to provide a nutritious snack for your child during break time.
(Refrigeration will NOT be provided for lunches, snacks, or drinks.)

Half day campers should bring a healthy, light snack.


All campers need a reusable water bottle each day of camp.

You may wish to provide an art smock for your child to help avoid messy stains on clothing. 

Please dress your child comfortably in cool, loose, layered clothing. Children will be dancing, painting, and doing other physical activities without changing clothes, so please make sure their clothing is adaptable and allowed to get messy.

Bare feet are best for dancing. If your child does not like to be barefoot while dancing, ballet or jazz shoes or other elastic-type slippers may be worn.

*Please make sure that your child's first and last name is on all items that your child brings to camp.*


OTHER IMPORTANT INFORMATION:

DO NOT park in the Reserved parking spaces of the Danceworks parking lots before 5pm. There is limited visitor parking available in the lot to the left of the Water Street parking lot entrance, and ample parking on the street.

Please DO NOT drive up to the Danceworks entrance to drop your child off. 


A parent/legal guardian (or person authorized for pick-up) MUST enter the building to sign their child IN AND OUT at the beginning and end of each camp
day. The person picking up your child must be 18 years or older.
MPS Partnership Survey Information

As part of the program, we will be evaluating our program by surveys, observations and/or interviews of all students. This may include a pre-test and post-test survey that will ask about what students are learning from our programs. Please be assured that your child’s privacy is important to us. Your child’s information will be added to the information of others in the program and reported only as a group. By being in the evaluation, your child will be helping us use the information to improve our program. 

 It is very important that all students in the program take part in providing evaluation information, but this is voluntary. If you choose not to allow data collection for your child, this will NOT affect your child’s participation in the program. If you do not want your child to take part in the evaluation, you will need to sign the form attached below and return it via email to tdrews@danceworksmke.org or in person on the first day of the program. There are additional copies at Danceworks if you would like to sign it at the start of the first day of the program. If you will allow us to collect information, there is nothing you need to do. Thank you!


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