Name of Individual/School/Organization _____________________________________________________________
School Address ________________________________________
City ________________________________
State _________
)____________________________________
School Fax (
Zip _______________ School Phone (
)________________________
School Mascot _____________________________________
Advisor/Coach __________________________________ Email _______________________________________
Home Phone (
)____________________________ Cell Phone (
)_____________________________
Mark the category which best describes your squad/team:
 Elementary  Jr. High/Middle
 JV/Freshmen
 Varsity  H.S. Co-ed  All-Star  College
Camp Selection:
 Camp/Clinic I:
Saturday, May 30, 2015
(1-Day Cheer & Dance Camp - $20/person – Baton Rouge, LA)
 Camp/Clinic II:
Saturday, June 6, 2015
(1-Day Cheer & Dance Camp - $20/person – Alexandria, LA)
 Camp/Clinic III:
Saturday, June 13, 2015
(1-Day Individual Dance Camp - $20/person – Lake Charles, LA)
 Camp/Clinic IV:
Saturday, June 20, 2015
(1-Day Individual Cheer Camp - $20/person – Houston, TX)
 Camp/Clinic V:
Saturday, June 27, 2015
(1-Day Cheer & Dance Camp - $20/person – New Orleans, LA)
 Camp/Clinic VI:
Sunday, July 5, 2015
(1-Day Open Cheer Stunt Clinic - $20/person – Baton Rouge, LA)
 Camp/Clinic VII:
Sunday, July 5, 2015
(1-Day Open Dance Master Class - $20/person – Baton Rouge, LA)
 Camp/Clinic VIII:
Saturday, July 11, 2015
(1-Day Open Cheer Stunt Clinic - $20/person – Shreveport, LA)
 Camp/Clinic IX:
July 15, 2015 – July 18, 2015 (4-Day Team Residential - $325/person – Baton Rouge, LA)
 Camp/Clinic X:
Saturday, July 25, 2015
 Camp/Clinic XI:
Saturday, August 8, 2015 (1-Day Open Dance Master Class - $20/person – Dallas, TX)
 Camp/Clinic XII:
Saturday, August 22, 2015 (1-Day Individual Cheer Camp - $20/person – Mt. Vernon, NY)
(1-Day Individual Cheer Camp - $20/person – Birmingham, AL)
 Private Camp (Proposed Dates) ___________________________________________
* All private camps are three days in length: Cheer - $175 per person Dance - $200 per person
** (NEW) Private Camp costs now include travel, hotel, and lodging for staff! No extra fees incurred to host a private!
Number of participants:
Method of Payment
______ Cheer/Dance
 Check
______ Mascot
______ Coach/Advisor
 Money Order (Make all checks/money orders payable to: MOKA or MOKA Cheer and Dance)
REGISTRATION PRICE
Number of Camp/Clinic Participants _______
x
_________
=
___________________
(Camp/Clinic Cost)
Number of coaches/advisors
_______
x
$225.00
=
___________________
Late Fee (if applicable)
_______
x
$25.00
=
___________________
Number of Private Participants
_______
x
$________
=
___________________
=
___________________
**Residential Camp Only
Total Cost
Payment Submitted
___________________
** NEW FEATURE!!! SIMPLY SCREEN SHOT THIS FORM AND TEXT IT **
225.324.9704
 This form is due by May 29, 2015. All squads registered by April 30th will receive a registration fee waiver for one advisor.
 All participants must complete an agreement of compliance form. Forms should be submitted with team registration.
 One-half (1/2) deposit is necessary for official registration.
 Final payment is due 3 weeks before the chosen camp begins for one’s registration to be complete. No refunds are
given on deposits. **If squad totals change before camp, teams are responsible for the number listed on registration!
 Has your squad ever participated in a summer camp? ___________
 If yes, which camp(s) has your squad attended within the last three years?
_______________________________________________________________________________
_______________________________________________________________________________
 Does your team compete? (If Yes: Local, Regional, National) ____________________________
 If yes, which competition(s) has your team competed in the last three years?
_______________________________________________________________________________
_______________________________________________________________________________
 What area does your squad deem the most critical need for summer instruction?
Cheer: (Cheers, Chants, Stunts, Pyramids, Baskets, Dance, Competitive Choreography, etc…)
Dance: (Kicks, Turns, Leaps, Stand Routines, Field Routines, Competitive Choreography, etc…)
_______________________________________________________________________________
_______________________________________________________________________________
 How did you hear about MCA/MDA? Please mark all that apply:
 Brochure/Flyer
 Internet
 Other _________________________________
 Staff Instructor (Name) ________________________________
 Another Coach/Director
 What is your squad’s favorite CHEER/DANCE SEASON?
 Summer Camp
 Football/Fall
 Competition
 Basketball/Spring
MOKA Cheerleading & Dance Association
P.O. Box 74109
Baton Rouge, LA 70874
(225) 324-9704
 Tryouts