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Call (519) 434-0612
        -- Or --
FAX: (519) 434-7898

...for an information packet.  Registration fee is $25.00

Special Note: Registration forms must be printed, filled out and sent to the studio along with the registration fee (cheque or money order only, please) to be processed. Please include signed student participation agreement.

To print the registration form, simply copy and paste it into a suitable word processor (MS-Word, WordPerfect, etc.) and print it.  You may have to adjust your margin settings.

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.

(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.





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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