Registration Form Camp

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CAMP REGISTRATION FORM

* Indicates required field

Student Name *

First

Last

Date of Birth *

Choose Any *

Female Male

Email *

Parents' Names *

Cell Phone *

Home Phone *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Pediatrician Name *

Pediatrician Phone # *

Medical alerts or special needs? *

If yes, please explain *

Does a sibling attend PSB? *

How did you hear about us? *

For ages 1.5-6 (check all that apply): *

Mommy & Me - 4 week class Coco Camp - June 18-22 Circus Camp - June 25-29 Nutcracker Camp - Aug 27-31

For ages 7-17 (check all that apply): *

Intensive - June 18-22 Intensive - June 25-29 Intensive - Aug 27-31

Credit Card *

All families are required to register a credit card.

Credit Card # *

Credit Card Expiration Date *

mm/yy

Security Code *

3 digit code on back of card

Billing address same as home? *

Yes No

If no, please enter Billing Address *

Anything else we should know? *

Submit

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Home
About
- Mission
- Faculty Bios
Programs
Classes & Calendar
Tuition & Policies
- Tuition
- School Policies >
  - Dress Code
  - Parking at PSB
Register
More Opportunities!
Merchandise
- Leotard Order Form
Contact
Gallery