En Pointe Dance Company

"Just Dance!"


Home

Class Descriptions

Class Schedule

Price List

Policies

EN POINTE DANCE COMPANY

 

 REGISTRATION FORM – FALL 2016/2017

 

STUDENT INFORMATION

 

STUDENT NAME: _______________________________________________ AGE: ___________________________

 

DATE OF BIRTH: ________/________/________ GRADE: _______ TODAY’S DATE: _______________________

 

PREVIOUS CLASSES: _____________________________________________________________________________

 

ANY HEALTH OR PHYSICAL RESTRICTIONS EN POINTE DANCE CO. NEEDS TO BE AWARE OF? 

 

YES: _________   NO: _________

 

IF YES, PLEASE EXPLAIN: ________________________________________________________________________

 

PARENT/GUARDIAN (BILLING) INFORMATION

 

PARENT #1: ____________________________________PARENT #2: ______________________________________

 

ADDRESS: _____________________________  CITY/STATE/ZIP: _________________________________________

 

HOME PHONE #: ____________________________WORK NAME/ #: _____________________________________

 

E-MAIL: ____________________________________________________ CELL #: _____________________________

 

IN CASE OF AN EMERGENCY, PLEASE CONTACT: __________________________________________________

 

PHONE #: (          )______________________________ OR (          )_________________________________________

 

DESIRED CLASSES

 

1. CLASS NAME: ________________________________DAY: _____________________TIME: ________________

 

2. CLASS NAME: ________________________________DAY: _____________________TIME: ________________

 

3. CLASS NAME: ________________________________DAY: _____________________TIME: ________________

 

NEW STUDENT    YES: ______   NO: ______  

 

MONTHLY RATE: ___________ AMOUNT DUE: _____________ CASH: ____________CHECK #: ____________

 

 

I (we) have read and understand the En Pointe Dance Company 2016/2017 dance season program information and studio policies.  I understand that participation in this dance program is voluntary and strenuous, and verify that I, and/or my child/children, are physically fit to participate. I waive and release En Pointe Dance Company, Allyson Conhartoski, instructors, their heirs and their assigns from any and all rights and claims for injuries suffered or medical expenses which may occur as a result in the participation in this dance season.

 

Parent/Guardian Signature: ____________________________________________ Date: ______________

 

Photography Release

 

I hereby grant absolute right and permission to En Pointe Dance Company to use photographic portraits of my child/children for illustration, promotion and/or advertising purposes. 

 

 I have read and agree to the above statement.   ______Yes     ______No

 

Please make checks payable to: En Pointe Dance Company

 

All questions regarding tuition and registration should be directed to and registration forms sent to: 

 

En Pointe Dance Company

Attn: Allyson Conhartoski, Director
610 Oak St. Hurley, WI 54534

 

Cell #: (906) 285-1704, e-mail: enpointedanceco@hotmail.com

 

 

Calendar

Pictures

About EPDC

Newsletter

EPDC Wear

EPDC Order Form

Summer Classes

Private Lessons

Contact Us