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Registration From
To Ensure Enrolment Please Fill In
This Form
Child's Name: ______________________________ Parent's
Surname: __________________________
(if different from child's)
Address: __________________________________ City: _______________ Postal Code:
___________
Telephone: (Home) __________________________ E-Mail:
___________________________________
(Bus.) __________________________ Fax:
_____________________________________
(Bus.) __________________________ Cell:
_____________________________________
Academic Day School: _______________________ Telephone:
________________________________
Age: (As of Sept.) __________________________ Birthdate:
_________________________________
We cannot guarantee a place for students if the level is filled or
if enrolment does not warrant a class. All former students must
"re-register" for placement in the fall class schedule.
ENCLOSE $25.00 REGISTRATION FEE PER FAMILY
(Non-Refundable / Non-Deductible From Tuition)
Check All Applicable Boxes
[ ] Student is a
beginner
[ ] Student has had previous study
[ ] Intro to Dance 1 [ ] Intro to
Dance 2 [ ] Intro to
Ballet [ ] Intro to Tap and Jazz
[ ] Ballet No. of classes
______________________________________________
[ ]
Pointework
[ ]
Modern
[ ] Intensive Scholar
[ ]
Jazz
[ ] Hip
Hop
[ ] Adult Ballet
[ ]
Tap
[ ] Endurance
Class
[ ] Adult Tap & Jazz
[ ] Dance
Gymnastics
[ ] Professional
Program
[ ] Performance Group Jazz
I prefer an [ ] Evening
class
Check if cannot attend: [ ] Friday
[ ] Saturday
[ ] Before 5:30 PM
Note days and times of students other activities.
We may not have a class to meet with other commitments.
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I agree to allow my child/myself to participate in the physical training at The London Dance Centre and that I/we are physically fit enough to participate in the activities at The London Dance Centre. I warrant that, my child or myself, has no known physical disabilities, illnesses or sicknesses which might be aggravated by active participation in the course of instruction at The London Dance Centre. Should I/we have any doubt as to our physical fitness for participation in the course of instruction at The London Dance Centre, we will seek a physician's recommendation first. I/we acknowledge the existence of some risk of personal injury in participating in physical activity at The London Dance Centre and I/we expressly agree to assume the risk of all injuries, death or property damage and agree to indemnify and save harmless The London Dance Centre from any and all liability, including all expenses, legal or otherwise, incurred by The London Dance Centre in the defense of any claim or suit.
Parent's Signature:
________________________________________________________________
Please Print Name: _______________________________________ Date:
___________________
Please list any information about the participant that might be informative to ensuring their best progress eg: asthma / orthopedic problems / hearing impairment / etc.
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