Encore! Registration Form

Fax completed form to 732-565-1473 or Mail to:
Encore! School of Performing Arts
44 Emerson Rd.
Somerset, NJ 08873

One Registration Form Per Student
Complete the web form below

Student's First Name: Student's Last Name:

Student's Birthdate: Year: (example: 1988)

Student's Gender: Grade Entering (September 2008):

Choose which camp(s) your child will be attending (you can choose more than one):
        Performing Arts Camp (Session 1, June 30 - July 18)
        Performing Arts Camp (Session 2, July 21 - August 8
        Adventure Camp (August 11 - August 22)

Please indicate which section your child will be enrolled in:
        Grades K-3 (9:30 AM - 12:30 PM)
        Grades 4-8 (9:30 AM - 3:30 PM)
        Grades 9-12 (9:30 AM - 3:30 PM)

Address 1:

Address 2:

City: State: Zip Code:

Home Tel. No. (example: 732-345-6789) Home e-mail:

Parent or Legal Guardian Name 1:

Work Tel. No. (example: 732-345-6789)

Cell Phone No. (example: 732-345-6789)

e-mail:

Parent or Legal Guardian Name 2:

Work Tel. No. (example: 732-345-6789)

Cell Phone No. (example: 732-345-6789)

e-mail:

Does the student have any medical conditions (include allergies) we should be aware of?

If yes, please specify:

Please list any medications the student is currently taking:

Please notify us in writing of any changes to the student's health condition or special needs.

Do you want before and after care to extend camp hours to 8:30 AM-5:30 PM for an additional $100 per week? (excludes Grades K-3)?

Charge:

Account Number: (include dashes)

Amount*: Expiration Date: (mm/yy)

Name as it appears on the card:

By checking below, I authorize Encore! School of Performing Arts to charge the credit card selected above for the amount completed above.

I authorize the credit card I have selected to be charged for the amount I have completed above.

* Performing Arts Camp
        Starbursts Mini-Camp: $335 per session
        Shooting Stars: $742 per session
        Mega Stars: $842 per session
Adventure Drama Camp
        Pioneers: $282 for 2-week session
        Venturers: $538 for 2-week session

Refund Policy:

Requests for refunds must be submitted in writing. Camp refunds, minus a $25 administrative fee and a $75 deposit fee, will be given according to the following deadlines:

Full refund (minus the fees above) is given if the request is received 60 days prior to the first day of the camp session, a 50% refund (minus the fees above) is given if the request is received 30 days prior to the first day of the camp session.

In the event that Dunn-ley Productions cancels the camp or a session, all fees will be refunded for the camp or session canceled.

No refunds will be granted for early camp withdrawal, absences or behavioral dismissals.

By checking below, I acknowledge that I have read and understood the refund policy and agree to the policy.

I agree to the refund policy as outlined above.

Please note that Encore! School of Performing Arts will make use of photographs, recordings, videos, etc. taken of students for use in advertising materials. If you wish your child to be excluded from said materials, please let us know.

Coupon Code: (Enter a coupon code here if you have one)

Check to be sure that all the information you have entered is correct.

Once the information is confirmed correct, click the submit button below to submit the form.