For each camper:
Name:
E-mail:
Phone:
Category (Regular, Work exchange, Full time student, Child under 18, Child under 5):
Requesting scholarship for: $
Is this your first time at camp?
Should we omit you form the camp directory?
Do you need a vegetarian meal?

For household:
Street:
City
State:
ZIP/Postal code: 

Can you give a ride?
Do you need a ride?
From/To:

Can you accommodate dancers at dances near you?

Total fees minus $25 for first time dancers: $
Total scholarship requested: $
501(c)3 tax deductible contribution to the scholarship Fund: $
Total enclosed ($50 minimum per person): $
Balance to be paid at camp: $

Thank you. Mail your form to:
Yvonne Crevier
177 Long Plain Road
Leverett, MA  01054
ATTN: Dance Camp Registration