1. art and entertainment
2. dance

Dance Centre North Summer Dance 2015 Registration Form:
(Must be completed in FULL for School enrollment – please print legibly)
Student’s Name: ____________________________________________________________________________
Parent’s Name: _____________________________________________________________________________
Address: __________________________________________________________________________________
City: _______________________________________ State: _____________________ Zip: _________________
Email: _____________________________________________________________________________________
Home Phone: __________________________________
Cell Phone: ________________________________
Emergency Phone Number: ____________________________________________________________________
Age: _________________
DOB: __________________________
Grade: _______________________
Former Training (new student’s only):____________________________________________________________
___________________________________________________________________________________________
Registering For:
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JULY 6 -10 DANCE INTENSIVE FROM 9:00 A.M – 4:00 P.M. $400.00 (LIST LEVEL) ___________________________
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YOUNG DANCERS’ SUMMER CAMP BLAST JULY 13 – 17 FROM 9:00 A.M. – 4:00 P.M. $175.00 _______________
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YOUNG DANCER SUMMER STUDIES PROGRAM JULY 20 – AUGUST 13 : (LIST LEVEL) _______________________
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SUMMER STUDIES PROGRAM JULY 13 –AUGUST 13 : (LIST LEVEL) ______________________________________
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When a student registers for a class division, they are required to take all ballet classes in that division, or comparable, when
authorized by the Director. Individuals wishing to attend Upper Level (Intermediate – Advanced) Jazz and Modern Classes that
are not registered in that division, will only be allowed with the Director/Faculty’s permission.
Tuition payments are payable in full at the time of registration with a $10.00 Non-Refundable Yearly Registration Fee for NEW
STUDENTS registering for the Summer Intensive. Students are registering for the entire Summer Intensive/Studies (4/5 weeks) and are
liable for the entire fee, unless they are unable to attend due to injury or health reasons, at which point a doctor’s diagnosis and letter
must be submitted to the School/Director for non-liability of the full tuition due. There are no refunds, pro-rating or credits applied
once the Summer Intensive/Studies has begun. Make-up Classes may be done with approval in other class levels.There is a $25.00 fee
for any returned checks.
IF YOU ARE UNABLE TO REGISTER FOR THE ENTIRE PROGRAM, PAYMENT BY THE CLASS ($18.00 PER CLASS) IS REQUIRED. PRO-RATED
RATES FOR MISSED WEEKS IS NO LONGER APPLICABLE. Make-up Classes may be done with approval in other class levels.
In order to reserve your child’s placement in Intensive/Camp or Classes and confirm the class is running, this Registration Form and a
$25.00 non-refundable deposit is due for all students (APPLICABLE TO TOTAL AMOUNT DUE). An additional $10.00 Non-Refundable
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Yearly Registration Fee is due for NEW STUDENTS. Payment to be paid to the office – BY FRIDAY, MAY 1 , 2015!
Liability/Waiver Statement: I/We realize that participation in dance classes and studio activities could involve some possible personal injury. Despite
precautions, accidents and injuries may occur. By signing below, I/We (the student and parent/guardian) assume all risks related to the use of any
and all spaces used by Dance Centre North. In addition, I/We agree to hold harmless Dance Centre North and its Director/Faculty and its facilities
used, from any cause of action, claims or demands now and in the future. I/We will not hold Dance Centre North and its affiliates, liable for any
personal injury, personal property damage, theft or loss, which may occur on the premises before, during or after
classes/rehearsals/performances/gatherings. I/We hereby assume all financial responsibility for the above registered student. In the event it
becomes necessary to refer this account to collections, you (parent/guardian) agree to be held liable for ALL collection fees, including legal fees,
interest, etc.
I, (parent’s name) ________________________________ hereby state that I have read and completely understand the above
mentioned and “policies” of Dance Centre North and will fully comply with the School requirements.
Students Name:_________________________________________________________________________
Parent’s Signature: ______________________________________________________________________Date: _________________
DEPOSIT DUE: $25.00
NON-REFUNDABLE YEARLY REGISTRATION (NEW STUDENTS ONLY) $10.00
TOTAL AMOUNT DUE:____________________________ PAID BY CASH/CHECK__________________________ DATE____________