JENNIFER PRETE SCHOOL OF DANCE
SUMMER REGISTRATION FORM
2010
NAME OF STUDENT: _________________________________________________________________________
AGE: _________________________________________ DATE OF BIRTH:_______________________________
MAILING ADDRESS:___________________________________________________________________________
EMAIL:_____________________________________________________________________________________
TELEPHONE: ________________________________________________________________________________
CELL PHONE:________________________________________________________________________________
PARENTS' NAMES:____________________________________________________________________________
AUTHORIZED ADULTS TO PICK UP STUDENT OTHER THAN PARENTS:__________________________________
KNOWN ILLNESSES/ALLERGIES:_________________________________________________________________
INSURANCE CARRIER AND POLICY NO.____________________________________________________________
YEARS OF DANCE EXPERIENCE IF ANY AND WHERE:_____________________________________________________________________________________
PLEASE CIRCLE WHICH CLASSES STUDENT WOULD LIKE TO TAKE:
-
PRE BALLET AND TAP $50/MONTH
-
AGES 5-7 COMBO (TAP AND JAZZ) $50/MONTH
-
AGES 8-10 COMBO (BALLET, TAP AND HIP HOP/JAZZ) $65/MONTH
- AGES 11-13 COMBO (TAP AND HIP HOP) $50/MONTH
- TEEN & PRE TEEN TAP $50/MONTH
- TEEN & PRE TEEN JAZZ $50/MONTH
- TEEN HIP HOP $45/ MONTH
- ADVANCED BALLET AND POINTE $50/MONTH
- TURNS, LEAPS AND JUMPS $50/MONTH
- CREW $50/MONTH
- MINI MODERN $50/MONTH
- MINI COMPANY $100/MONTH
- JR. AND SR. COMPANY $200/MONTH
- PRE TEEN AND TEEN MODERN $50/MONTH
- STRENGTH AND CONDITIONING $50/MONTH
- ADULT TAP AND JAZZ $50/MONTH OR CLASS CARDS AVAIL.
***HOW OUR PRICING WORKS:
YOUR FIRST CLASS IS THE PRICE LISTED ABOVE AND EACH ADDITIONAL CLASS IS $25, NOT THE LISTED PRICE. IF YOU TAKE ONLY ONE CLASS LISTED ABOVE, IT IS THE LISTED PRICE.
The Jennifer Prete School of Dance, its instructors, and volunteers are not liable for personal injuries or loss of, or damage to personal property. Each student may decline to participate in any activity and is responsible for informing the instructor or the Director of any limitations, physical or other, which may prevent full participation in the activity.
I hereby assume the risk for any injury that I/my child may sustain while participating in the activities offered at The Jennifer Prete School of Dance. "Activities" include all in-house activities, as well as off-site activities, including, but not limited to conventions, competitions, dress rehearsals, recitals, etc. I agree to release and hold-harmless and forever discharge The Jennifer Prete School of Dance, its officials, faculty and staff, agents, other employees or volunteers from any actions, suits, damages, claims or judgments that may result from any personal injury that my child sustain while on the premises of The Jennifer Prete School of Dance and at all off-site activities offered to my child.
I HAVE READ THIS ENTIRE RELEASE AND AGREE TO IT:
Parent/Guardian________________________________________________________
Please send completed registration form to:
email: jennifer@jpsdri.com
address: 1 Charlestown Beach Road, Charlestown, RI 02813
fax: (401) 633-7168
