Registration Form

APPLAUSE DANCE ACADEMY Please Print & Fax Form to: 585-1634 or Mail to: 1363 Rose Street Regina, Saskatchewan S4R 1Z7 Ph: (306) 352-4950 www.applausedanceacademy.bravehost.com Dancer`s Name_____________________________________________________________ Address___________________________________________________________________ Postal Code_______________________ Phone (Day)________________(Night)______________ cell_______________________ Email ____________________________________________________________________ Students Only: Age on December31st______Birthdate / Month______ Day_______ Year_____________ Mothers Name & Phone_______________________________ cell___________________ Address (if different than above) _________________________________________________________________________ Fathers Name & Phone______________________________ cell____________________ Address (if different than above) _________________________________________________________________________

Classes:           

Pre-School Dance Tap/Ballet Tap/Jazz Modern Ballet Pointe Hip Hop Tap Musical Theatre Jazz Lyrical

 Adult Hip Hop o Beginner o Advanced-Beginner o Inter/Advanced  Adult Ballet  Adult Lyrical  Adult Jazz o Beginner (Luigi Jazz) o Inter/Advanced  Adult Tap o Beginner o Intermediate o Advanced

Does your child have any medical condition that the Staff should be aware of? Yes

No

If yes, please specify:

How did you hear about us?

Why did you decide to register?

I certify that____________________________(dancer) is physically capable of participating fully in dancing activities at Applause Dance Academy. ___________________ Students Signature (18+)

_________________ Parent / Guardian

___________ Date

Your Registration Fee $30.00 must accompany this Registration Form. Each monthly payment from September to May is the same amount, regardless of the number of weeks in that month. June fees will be calculated at the single class price according to the number of lessons each student will receive before recital or the monthly fee, which ever is less. Please Note: There is no fee adjustment for illness or when classes are missed. In the event that a student must discontinue classes, we require one month’s written notice, with the final month’s fees.

Thank you for dancing at Applause! Barbara Miller The purchaser may cancel this agreement within 14 days after signing by forwarding written notice by registered mail, fax or personal delivery to Applause Dance Academy at: 1363 Rose St. Regina, Sask. S4R 1Z7