OLD 2022 Registered Camper Form

Please complete and submit the Registered Camper Form (below) ASAP but no later than three weeks prior to your camp session/s.

Full disclosure is appreciated here! This form is where you'll tell us more about your camper and provide us with her emergency contacts, plans for check-in / out, insurance details, health history / medication info, and roommate request if she has one (note: if two campers are requesting each other, we always honor mutual requests!).

Note: This form is easiest to complete if you're using google chrome with high speed wifi!

Also Note: If you e-sign forms (as suggested below), please download the completed form to upload here (it doesn't happen automatically)!

To submit this form, you'll need the following items ready for upload:

1. A photo of your camper (headshot preferred)
2. A picture of your camper's insurance card (front & back)
3. A signed ADTC Release of Liability & Assumption of Risk Agreement (easiest way? parent/camper e-sign it here)
4. A signed ADTC Family Code of Conduct (easiest way? parent/camper e-sign it here)
5. The ADTC Youth Camp Health Form or your equivalent school/sports health form signed by a licensed health professional and dated no earlier than 2 years prior to attending ADTC. Please have your camper's immunization records handy for upload as well (if your camper is not fully vaccinated, including for COVID-19, you must submit our Immunization Exemption Request Form ~ e-sign it here or sign the pdf here)
6. A signed Medication Form for over-the-counter medications that may be given "as needed" at camp (easiest way? parent e-sign it here)*

* Note: if your camper will be checking in any prescription medications to be administered at camp, we require a prescriber's signature on the Medication Form. Download & share it with them or invite them to e-sign it here. All medications must be given to the nurse in a large ziploc bag (sealed & labeled in original packaging) along with this form at check-in.

Please also read and be familiar with ADTC's Mission/Manifesto, Camp Policies & COVID-19 Protocols. And if you have a recent dance video of your camper, please have it ready to upload (if not, no worries - this is optional & we provide space for you to tell us more about her dance background & experience below, if desired). Please wait to begin filling out this form until you have the items above ready for upload.

Email
This field is for validation purposes and should be left unchanged.
Your Name*
First Last
Your Contact Email*
ADTC Location (please choose all that apply)*
- Vermont
- California
- North Carolina
- Maryland
- Colorado
- Texas
- Wisconsin
Session Start Date*
Number of Weeks*
CAMPER INFO
One camper per form, please.
Camper's Name*
First Last
Nickname (or preferred name)
Camper's Birth Date*
Month
Day
Year
Grade NEXT Year (2022 - 23)*
Age (at time of camp)*
Is Camper an ADTC Alumni?*
- Yes
- No
Number of summers at ADTC (including 2022)*
Camper's dance ability*
Note: We screen dancers for group placement upon arrival at camp. No dance experience is necessary to attend any ADTC session. Answers are used as a guide and do not guarantee placement in any specific group or level.
- Non-Dancer
- Beginner
- Intermediate
- Advanced
Dance styles studied*
Check all that apply. No dance experience is necessary to attend ADTC!
- Jazz
- Hip Hop
- Contemporary
- Lyrical
- Modern
- Broadway
- Tap
- Ballet
- Other
Please list other dance styles
Please provide dance videos or additional info about your camper's dance experience:
Note: This section is optional! Since dance teams will function like smaller cohorts at camp this summer, ANY additional info you provide here is helpful for group placement. You can also provide links to dance videos, or upload videos here (if uploading, please enter your dancer's full name when prompted).
Upload a photo of your camper*
A headshot is best, if you have one.
Drop files here or

Max. file size: 512 MB.
Camper's Email
We'll update camper with exciting info re: their camp session...staff bios, schedules, local events, and more!
Camper's Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is the camper coming to ADTC alone, with friend(s), or with a group/team?*
70% of ADTC campers attend camp alone (but leave with many new friends!). The other 30% of ADTC campers attend with a friend or group of friends. If your camper comes solo to ADTC, she'll be bunked together with another solo camper around her age.
Camper's Roommate Request
Note - for campers requesting just one roommate, we always honor mutual requests!
First Last
Please list additional girls attending ADTC with your daughter*
These girls may not be in same room, but they may be placed in neighboring room/s.
Any special requests or concerns regarding your camper's roommate(s)?
Does the camper have any prior overnight camp experience?*
Has the camper experienced homesickness during prior camps/nights away from home?*
Parent's Letter to her ADTC Counselors (Optional)
Please use this letter to:
1) Share any relevant family background information that may impact your daughter's overnight camp experience;
2) Please list three goals you'd like to see your camper achieve or show progress toward while she is at ADTC.
3) Please list three things the camper is looking forward to learning / doing while at dance camp.
EMERGENCY CONTACT INFO
This information is gathered to assist us in identifying appropriate care. Update required annually.
Custodial Parent/Guardian #1 Name*
Person with primary legal custody of the camper, with whom the camper lives the majority (if not all of) the time. This person will be our first point of contact for all issues regarding the camper before, during and after her week/s at ADTC.
First Last
Relationship to Camper*
Mobile Phone*
Email*
Home Address
Only if different from camper's home address.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Will you be at your home address while your daughter attends ADTC?*
- Yes
- No
- Not Sure
What address will you be at while your daughter attends camp?*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Guardian #2 or Emergency Contact Name*
First Last
Relationship to Camper*
If other, what is relationship to camper*
Mobile Phone*
Email*
Emergency Contact #3 (this is who we'll contact if neither person #1 nor person #2 is available)*
First Last
Relationship to Camper*
If other, what is relationship to camper*
Mobile Phone*
Email*
CAMPER CHECK-IN
Check-in is Sundays from 2 - 4pm. Arrivals before 12pm noon on Sunday are subject to a $20 early check-in fee. Saturday arrivals are subject to a weekend stay over fee (varies by camp location). We generally cannot accommodate add-a-day arrivals before our first session of camp.

Please contact our National Office if you need to make arrangements for an early check-in or change any other info below:
info@danceadtc.com or 866-383-ADTC (2382).
How is camper getting to ADTC for check-in?*

Note: In 2022, we encourage parents to drive their campers to camp themselves. If carpooling is necessary, campers should limit the number of people sharing a vehicle to three: two campers + one parent. Passengers should also consider testing, wearing masks, and adding fresh air through vents & open windows.
Name of friend's parent or other authorized person who is checking camper in*
First Last
Mobile phone number of person checking camper in*
Name of Shuttle Company & Driver*
Mobile Phone Number of Driver*
Mobile Phone Number of Camper*
* Camper will check-in her cell phone with our office when she arrives at camp, but she must have her phone with her (fully charged and turned on) while traveling to camp in case we need to reach her.
CAMPER CHECK-OUT
Check-out is Saturdays from 9 - 11am, but we are able to accommodate campers who need to check out early on Friday evenings after the all-camp show. Please be prepared to show a valid ID when signing your camper out with our office. All canteen & activities charges must be settled at check-out.

Departures after 12pm noon on Saturday are subject to a $20 late check-out fee. Sunday departures are subject to a weekend stay over fee (varies by location). We generally cannot accommodate add-a-day departures our last session of camp.

Please contact our National Office if you need to make arrangements for an early / late check-out or change any other info below:
info@danceadtc.com or 866-383-ADTC (2382).

In 2022, we must advise all camper families to limit your contact with others, especially high-risk individuals, for at least two weeks after returning home from camp.
How is camper getting picked up from ADTC?*

Note: In 2022, we encourage parents to pick their campers up from camp themselves. If carpooling is necessary, campers should limit the number of people sharing a vehicle to three: two campers + one parent. Passengers should also consider testing, wearing masks, and adding fresh air through vents & open windows.
Name of friend's parent or other authorized person who is checking camper out*
Note: Your daughter will not be permitted to leave camp with anyone you do not authorize here. If plans change after submitting this form, please contact the National Office: info@danceadtc.com or 866-383-ADTC (2382)
First Last
Mobile phone number of person checking camper out*
Name of Shuttle Company & Driver*
Mobile Phone Number of Driver*
INSURANCE INFO & RELEASE
All campers must have medical insurance to attend camp. Your personal medical policy is your child's primary coverage. Please have a picture or scanned copy of your camper's family insurance card ready for upload below.

* Note: If a camper sustains an injury or gets an illness at camp, parents are required to pay for any out-of-pocket expenses and then submit the claim to their insurance company. Parents are responsible for paying all physician's fees and prescription costs incurred by their child at camp. If you do not have medical insurance, or if your camper won't be covered out of state, please look into temporary medical insurance! We recommend Travmark or Insure My Trip.
Please attach a picture of your camper's insurance card (front & back)*
Drop files here or

Max. file size: 512 MB.
Policy Holder's Name*
First Last
Social Security Number of Policy Holder
Name of Insurance Company*
Phone Number of Insurance Company*
Policy Number*
Group/ID Number
Name of Family Physician*
First Last
Physician Phone*
Name of Family Dentist / Orthodontist
First Last
Dentist Phone
Upload your Release of Liability & Assumption of Risk Agreement & ADTC Family Code of Conduct*
Parent AND camper must read & sign both forms:
1) ADTC Release (e-sign it here or sign pdf here)
2) Code of Conduct (e-sign it here or sign pdf here)
Drop files here or

Max. file size: 512 MB.
HEALTH HISTORY
Full disclosure is appreciated here. We're best able to care for your daughter when we know as much as possible about her! For all "yes" answers, please provide additional details, including date of onset, name & phone number of treating doctor, previous and current treatments, date of last symptoms, and any other relevant info.
Upload your camper's Physical Exam*
We'll accept either 1) the ADTC Youth Camp Health Form, or 2) your equivalent School/Sports Form, as long as the form is signed by a licensed health professional and dated no earlier than 2 years prior to attending ADTC.
Drop files here or

Max. file size: 512 MB.
Is camper fully immunized?*
Note: ADTC is following American Camp Association & CDC guidelines for overnight camps again in 2022. In addition to routine immunizations (Measles, Mumps, Rubella, Chicken Pox, Tetanus, Hepatitis B, Diphtheria, Pertussis, Pneumococcal Conjugate, Polio, etc.), we strongly prefer all campers to be fully vaccinated for COVID-19, and encourage boosters for eligible campers - eligibility is detailed here.
Upload your camper's Immunization Records & COVID Vaccination Card*
We'll accept a picture or copy of the camper's immunization forms from health-care providers or state or local government. For proof of COVID vaccination, we require a picture or copy of a CDC-issued vaccination card including the name of the vaccinated camper, the type of vaccination provided and the dates the doses were administered.
Drop files here or

Max. file size: 512 MB.
Upload your camper's Immunization Exemption Request Form*
E-sign it for upload here or sign pdf here. Please also upload any records of vaccinations your camper does have (we'll accept a picture or copy of any immunization forms from health-care providers or state or local government, etc).
Drop files here or

Max. file size: 512 MB.
Does camper have any condition that may mimic the symptoms of COVID-19?*
Refer to symptoms of COVID-19 here.
Details*
Name or type of illness, symptoms, etc.
Does camper have a medical diagnosis that is considered high-risk or that could put her at increased risk of complications with COVID-19?*
Details*
Does your camper take any medications?*
Upload your camper's Signed Medication Form*
For over-the-counter medications that may be given "as needed" at camp. E-sign it here or sign pdf here.
Drop files here or

Max. file size: 512 MB.
Upload your camper's Signed Medication Form*
If your camper will be checking in any prescription medications to be administered at camp, we require a prescriber's signature on the Medication Form. Download & share it with them or invite them to e-sign it here. All medications must be given to the nurse in a large ziploc bag (sealed & labeled in original packaging) along with this form at check-in.
Drop files here or

Max. file size: 512 MB.
Does camper have any dietary restrictions?*
Check all that apply*
- Does not eat red meat
- Does not eat poultry
- Does not eat pork
- Does not eat seafood
- Does not eat eggs
- Does not eat dairy products
- Other
Details*
Does camper have any known allergies to medications, food, insects, animals, etc.?*
Details*
Has camper had any recent injury, illness or infectious disease?*
Details*
Does camper have any chronic or recurring illness/condition?*
Details*
Has camper ever been hospitalized?*
Details*
Has camper ever had surgery?*
Details*
Does camper have frequent headaches?*
Details*
Does camper have asthma, wheezing or shortness of breath?*
Details*
Has camper ever had problems during exercise (dizziness, fainting, chest pain, etc.)?*
Details*
Has camper ever had seizures?*
Details*
Has camper ever had problems with diarrhea / constipation?*
Details
Does camper have a history of bed wetting?*
Details*
Does camper have problems falling asleep or with sleepwalking?*
Details*
Does camper wear glasses or contacts?*
Details*
Has camper ever had back or joint problems?*
Details*
Does camper have any skin problems?*
Details*
Does camper have diabetes?*
Details*
Has camper had "mono" in the past 12 months?*
Details*
Has camper traveled outside the country in the past 9 months?*
Details*
Does camper have problems with periods / menstruation?*
Details*
Has camper ever been treated for attention deficit disorder (ADD) or attention deficit hyperactivitity disorder (ADHD)?*
Details*
Has camper ever been treated for emotional or behavioral difficulties or an eating disorder?*
Details*
Has camper seen a professional to address mental/emotional health concerns during the past 12 months?*
Details*
Has camper had a significant life event that continues to affect her (abuse, death of a loved one, divorce, adoption, foster care, survived a disaster)?*
Details*
BEHAVIOR AT CAMP AGREEMENTS
Parents, please review the agreements below with your camper before signing.
I have read the ADTC manifesto, policies regarding camp rules and expected behavior at camp, policies regarding keeping in touch outside of camp, the ADTC no cell phone policy & COVID-19 protocols.*
ADTC Manifesto
ADTC Policies
COVID Info
- I have read the material
I agree to follow and help uphold each of ADTC's camp rules. I agree to listen to, respect and be responsible to the camp's staff and Program Director.*
- I agree
I agree to respect the camp, the facility, all ADTC faculty and all fellow campers. I understand that disrespect, rudeness and profanity are NOT tolerated. I understand that ADTC is a positive place and that teasing, making fun, discriminating, bullying or putting down anyone will not be accepted under any circumstance.*
- I agree
I understand that tobacco products, alcohol, drugs, or weapons are never allowed at ADTC.*
- I understand
I agree to respect the property of fellow campers and understand that stealing is never tolerated. I understand that I will be held responsible for any intentional property damage, including damage caused by reckless or irresponsible behavior, to ADTC property or to the property of fellow campers.*
- I agree
I understand that cell phones, computers or similar devices are not allowed at ADTC, except for call home night. If I am bringing my cell phone, I will check it in with camp staff upon arrival.*
- I understand
I understand that I am never allowed to leave the camp area unsupervised. I will use the buddy system everywhere I go outside of the camp dorm, and be sure I have counselor permission. I will not lose my room key.*
- I understand
I understand that if I disobey the rules of our camp and/or negatively affect the experiences of other campers or ADTC staff, I will be sent home from camp immediately and without refund.*
- I understand
Parents: I understand that ADTC has a zero-tolerance policy for inappropriate behavior as defined above and by the camp and its directors. I understand that if my child is found to be breaking camp rules and is required to leave camp, I will need to make arrangements for immediate pick-up of my child, and that no refund will be possible.*
- I understand
I understand that if my child loses the keys to her room and/or the dorm, I will be required to pay a re-keying charge as dictated by the camp facility. This charge can range from $50 - $100.*
- I understand
I understand that COVID-19 is a known risk, and refunds will not be granted for camp attendance lost due to COVID infection, exposure, or policy changes. I acknowledge that ADTC is taking reasonable measures to prevent the transmission of COVID-19 consistent with applicable public health guidelines. I also recognize that it is impossible to ensure that the camp and facilities are 100% free of COVID-19 and that being at camp contains inherent risks that cannot be eliminated regardless of the care taken to avoid the spread of COVID-19. I acknowledge, understand, and appreciate that these and other risks are inherent in participating in camp.*
- I understand
Camper's Digital Signature*
First Last
Custodial Parent / Guardian Digital Signature*
First Last
Today's Date*
MM slash DD slash YYYY