2011/2012 Fall/Spring Registration Form
Please contact us for our class pricing.
$20 registration fee (individual)
$30 registration fee (family)
$10 company and crew registration fee
Registration fees are non refundable.
STUDENT’S NAME: _____________________________________________________
STUDENT’S AGE: _____________________________________________________
DATE OF BIRTH: _______________________________(please include year)
CLASS CHOICES (Please circle):
CHILDREN’S COMBO CLASSES
- Pre Ballet and Tap
- Combo 1 - AGES 5-7.5 (ballet, tap & jazz)
- Combo 2 - AGES 8-11 (ballet, tap & hip hop)
- Combo 3 - AGES 11.5-13 (ballet, tap & hip hop) [company dancers are required to take jazz]
- Mini Modern
JUNIOR TEEN, SENIOR TEEN & ADULT CLASSES
- Ballet
- Tap
- Jazz
- Hip Hop
- Modern/Contemporary
- Pointe
- Zumba
PERSONALIZED CLASSES
COMPETITIVE LEVEL CLASSES:
- Junior and Senior Company
- Mini Company
- Petite Company
- Crew
- Mini Crew
NAME OF PARENT/GUARDIAN: ________________________________________
MAILING ADDRESS:___________________________________________________
HOME PHONE: _____________________________________________________
CELL PHONE: _____________________________________________________
EMAIL: _____________________________________________________
WOULD YOU LIKE TO BE A FRIEND ON FACEBOOK TO RECEIVE NOTICES FROM THE STUDIO? Y/N
INDIVIDUALS AUTHORIZED TO PICK UP YOUR CHILD:
1.)
2.)
3.)
4.)
5.)
MEDICAL CONDITIONS/ALLERGIES OF STUDENT:_________________________
INSURANCE CARRIER AND POLICY NO.:________________________________
DANCE EXPERIENCE: (if so, where and how many years):
______________________________________________________________________________________________________________________________
TEACHER’S NOTES (to be filled in by teachers only)
PLACEMENT:
MONTHLY TUITION: $
AT REGISTRATION PAID: $____________________ AND OR REG. FEE OF $10/$20/$30
NOTES:
