Registration Form: 2020-2021 Season | La Pointe Dance Studio

Student Information

Student First Name *

Last Name *

Birthday (YYYY/MM/DD) *

Student Phone

Student Email

Address *

Postal Code *

Previous dance training:

Physical or medical problems:

Parent Information

At least one contact number must be provided. The more the better.

Father Name

Last Name

Phone: Home

Phone: Mobile

Phone: Work

Mother Name

Last Name

Phone: Home

Phone: Mobile

Phone: Work

In case of emergency (during class) notify

Email for school communication

Please provide at least 1 email and up to 2 additional emails for us to send all the school communications.
If you want the student to get the school communications, please include the student's email here as well.

Email 1 *

Email 2

Email 3

Classes

Select all classes that apply.
Make sure to include all the desired days for classes offered multiple days in the week.

Introduction to Ballet Classes:

Pre-School Dance - Tuesday

Pre-Primary Ballet (ages 5-6) - Saturday

Ballet Grades Classes:

Ballet Vocational Classes:

Modern Classes:

Modern Junior - Tuesday

Modern Senior - Tuesday

Contemporary - Monday

Hip Hop Classes:

Hip Hop Level 1 & 2 - Friday

Hip Hop Level 3 - Friday

Tap Classes:

Tap Level 1 - Friday

Tap Level 2 - Friday

Tap Level 3 - Friday

Other Classes:

Adult - Saturday

PBT Junior - Monday

PBT Senior - Monday

The following classes are FULL:

Please select to be added to a waiting list. If enough people are in the waiting list a second class may be added

WAIVER

*

As the parent or legal guardian , I authorize La Pointe Dance Studio to seek medical service in case of serious injury or illness if I am unable to be contacted. I further agree or accept financial responsibility in excess of benefits allowed by my health plan I give my voluntary consent to his/her participation in all dancing programs and activities provided by La Pointe Dance Studio, its principal, employees and agents. I release La Pointe Dance Studio from any and all liability and waive as against La Pointe Dance Studio all recourse, loss or damage, including any consequential damage or loss, claims, causes of action of any kind whatsoever arising from his/her participation in the activity. I acknowledge by their very nature, that the activities engaged in can be dangerous exposing participants to risks and hazards such as, but not limited to, physical injuries incurred while dancing; and that I nevertheless freely and voluntarily assume all of the aforesaid risks and hazards I hereby authorize photos or videos to be taken of him/her for promotional or advertising purposes It is herby understood and agreed that La Pointe Dance Studio shall not be responsible for any theft, damage or injuries incurred during classes or on location premises. La Pointe Dance Studio shall not be responsible for his/her care before and after class

Acknowledgement

*

I acknowledge that I read and understood the Registration Information, including the Withdrawal Policy and General Policies

How did you hear about us?

Signature of parent or Guardian *

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