*Student's Name
*DOB(mm/dd/yyyy)
*Street Address
*City
*State(XX)
*Zip
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| *Home Phone (xxx-xxx-xxxx) |
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| * Emergency Phone (xxx-xxx-xxxx) |
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| Cell Phone (xxx-xxx-xxxx) |
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| Work Phone (xxx-xxx-xxxx) |
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| *Email Address |
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| *Person Responsible for Payments |
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Camps |
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Ballet Intensive |
July 13, 14, 15 |
9:00-12:00 |
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Camp Rock & Dance |
Dates
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10:30-12:00 |
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Pretty Princess Camp |
Dates
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9:00-10:30 |
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Week Long Dance Camp |
July 19-23 |
9:00-3:00 |
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| Acrobats |
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Tiny Tots |
Day/Time
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Session
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Pre Acro |
Wednesday/4:30-5:25 |
Session
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Acro 1 & 2 |
Tuesday/5:30-6:25 |
Session
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Acro 3 & 4 |
Tuesday/6:30-7:25 |
Session
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Cheer/Pompon Acrobatics |
Wednesday/6:00-6:55 |
Session
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High School Cheer/Tumbling |
Wednesday/7:00-7:55 |
Session
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| Dance |
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Ballet 1 & 2 |
Monday/5:30-6:25 |
Session
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Teen/Adult Ballet |
Monday/6:30-7:25 |
Session
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Beginning/Intermediate Clogging |
Wednesday/4:30-5:25 |
Session
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Hip Hop 1 & 2 |
Tuesday/4:30-5:25 |
Session
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Hip Hop 3 & 4 |
Tuesday/7:30-8:25 |
Session
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Lyrical Jazz |
Monday/7:30-8:25 |
Session
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| Acro/Dance Combo |
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Pre Ballet/Acro |
Day/Time
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Session
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Ballet/Tap/Jazz |
Saturday/10:30-11:25 |
Session
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Pre Ballet/Tap |
Monday/4:30-5:25 |
Session
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| Kindermusik-5 Week Classes |
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Village (0-18months) |
Tues, June 8, 15, 22, 29 & July 6/9:30 |
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Our Time (18 mo-3 yrs) |
Day/Time
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Imagine That (3-5 yrs) |
Wed, June 9, 16, 23, 30 July 7/5:00 |
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| Music Program-someone will contact you with available times |
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Piano Lessons |
Tues & Wed/4-7pm |
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Clarinet Lessons |
Tues & Wed/4-7pm |
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Beginning Voice Lessons |
Tues & Wed/4-7pm |
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By submitting this form, I understand that there is potential for injury with participation in any sport, including classes at Katie’s Dance Studio; and, while at Katie’s Dance Studio, its owners, directors and teachers will make every reasonable effort to eliminate potential for injury, such injury may still occur. I understand this risk and agree to hold Katie’s Dance Studio, its owners, directors and teachers harmless from any and all liability connected with any injury arising out of participation in classes at Katie’s Dance Studio.
I have read and understand that no refunds are given unless a class/camp is cancelled by Katie’s Dance Studio. Full payment is due for enrollment to be complete and space reserved.
*
I have read and fully understand the above agreement. |
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