*Student's Name
*DOB(mm/dd/yyyy)
*Street Address
*City
*State(XX)
*Zip
|
| *Home Phone (xxx-xxx-xxxx) |
|
| * Emergency Phone (xxx-xxx-xxxx) |
|
| Cell Phone (xxx-xxx-xxxx) |
|
| Work Phone (xxx-xxx-xxxx) |
|
| *Email Address |
|
| *Person Responsible for Payments |
|
| *Payment Plan (A, B or C) |
|
| *How do you plan to pay? |
|
| |
| Acrobats |
|
Tiny Tots |
Day/Time
|
|
|
Pre Acro (ages 3-5) |
Thursday/4:30-5:25 |
|
|
Acro 1 |
Day/Time
|
|
|
Acro 2 |
Monday/6:05-7:00 |
|
|
Acro 2 & 3 |
Friday/6:30-7:25 |
|
|
Acro 3 |
Tuesday/6:05-7:00 |
|
|
Acro 4 |
Monday/7:05-8:00 |
|
|
Acro 5 |
Tuesday/7:05-8:00 |
|
|
Tumble Team |
Day/Time
|
|
| |
| Acro/Dance Combo |
|
Pre Ballet/Acro |
Day/Time
|
|
|
Ballet/Acrobatics
|
Saturday/10:30-11:25 |
|
| |
| Dance |
|
Kinderdance |
Wednesday/5:30-6:25 |
|
|
Pre Tap/Ballet |
Monday/4:30-5:25 |
|
|
Ballet/Tap |
Friday/4:30-5:25 |
|
|
Ballet 1 |
Monday/5:30-6:25 |
|
|
Ballet 2 |
Monday/6:30-7:25 |
|
|
Ballet 3 |
Thursday 7:30-8:25 |
|
|
Ballet 4 |
Monday/7:30-8:25 |
|
|
Teen/Adult Ballet |
Thurday/6:30-7:25 |
|
|
Pointe |
Monday/8:30-9:15 |
|
|
Beginning Cheer |
Tuesday/4:30-5:25 |
|
|
Inter/Adv Cheer |
Thursday/5:30-6:25 |
|
|
Adult Clogging |
Wednesday/8:20-9:15 |
|
|
Beginning Clogging |
Thursday/5:30-6:25 |
|
|
Intermediate Clogging |
Thursday/6:30-7:25 |
|
|
Advanced Clogging |
Thursday/7:30-8:25 |
|
|
Clog Team |
Thursday/8:30-9:00 |
|
|
Boys Athletic Dance (ages 6-9) |
Friday/4:30-5:25 |
|
|
Boys Hip Hop/Breakdancing(ages 10 & up) |
Tuesday/8:30-9:25 |
|
|
Beginning Hip Hop |
Day/Time
|
|
|
Intermediate Hip Hop |
Day/Time
|
|
|
Advanced Hip Hop |
Wednesday/6:30-7:25 |
|
|
Teen/Adult Hip Hop |
Tuesday/7:30-8:25 |
|
|
Beginning Jazz |
Tuesday/6:30-7:25 |
|
|
Intermediate Jazz |
Monday/8:05-9:00 |
|
|
Advanced Jazz |
Tuesday/8:05-9:00 |
|
|
Lyrical Jazz |
Wednesday/8:30-9:25 |
|
|
Intermediate Tap |
Wednesday/6:30-7:25 |
|
|
Advanced Tap |
Wednesday/7:30-8:25 |
|
|
Dance Team/Dance Co. |
Wednesday/7:30-8:15 |
|
| |
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.
By submitting this form, I will abide by the policies and procedures described. I have read, understand and agree with the studio policies, procedures, fees and payment schedule.
*
I have read and fully understand the above agreement. |
|
