Dance Boot Camp Dance Boot Camp Parent Name First Last Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Family Phone Number*Family Email Student Name First Last Student AgeGroup 1Mondays 4-7 $50 per day July 8th July 15th July 22nd July 8th & 15th July 8th & 22nd July 15th & 22nd All 3 Group 2Wednesdays 5:15-7:45 $40 per day July 10th July 17th July 24th July 10th & 17th July 10th & 24th July 17th & 24th All 3 Group 3Wednesdays 4:00-5:15 $25 per day July 10th July 17th July 24th July 10th & 17th July 10th & 24th July 17th & 24th All 3 Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name
