Please print and mail your registration form and
A Cinderella's Dream
P.O. Box 924912
Houston, Texas 77292-4912
Address ___________________ City _____________ State ____ Zip Code
Date of Birth: _______________
Male / Female Grade _______ Age
Parent/Guardian/Name ______________________________Phone ______________
email: ___________________________________ Cell
Emergency Contact: Name _______________________ Phone ________________
1) The students will receive instruction, guidance, and encouragement.
2) The sponsor (A Cinderella's Dream-Camp/Class Director) reserves the
dismiss any student whose
conduct proves not to be in harmony with the camps'
3) A Cinderella's Dream reserves the right to cancel or alter any
scheduled course if
necessary. If a course is canceled, camp, class or workshop fees
will be refunded.
4) I understand that no camp, class or workshop fees will be refunded once
If you cancel a class, we will reschedule your time.
5) A non-refundable fee of $25.00 is required to reserve your space.
The balance of camp, class or workshop will be due on or before the first day of instruction.
________________________ Date ___________
Medical Release & Waiver Agreement
I agree to release and hold harmless A Cinderella's Dream, and it's
instructor's from any
and all losses, liabilities, claims, and expenses that may occur as a result of my child/myself
participation in any camp, class or workshops.
Name and Phone #: _________________________________________
Physician's Name: ___________________________ Phone #: _________________
Special Needs: _______________________________________________________
Known Allergies: _____________________________________________________
In the event of
an accident or injury to my child, I hereby give my consent for
Dream director and staff to arrange medical treatment for my child/myself
the event I cannot be reached. I understand that I will be financially responsible for any
or service given to my child/myself.
_________________________ Date: ___________
I give A Cinderella's Dream permission to use photos taken of my child/myself
or class for publication of its website and or for advertisement purposes only. ___Yes ___
We will not use any names.
Signature: __________________________ Date: _________
Cost: __________ Payment: __________ Balance Due: __________ Check # ___________