Registration Form located at bottom of Page

 






Registration - Everyone needs to fill out the entire form to register for the summer programs!



 * required item
Billing Name:*
Billing Address:*
City:*     State:*     Zip:*
Home Phone:*
Work Phone:
Email Primary Parent:*


Parent 1 Full Name:
Home Phone:
Work Phone:
Cell Phone:


Parent 2 Full Name
Home Phone:
Work Phone:
Cell Phone:


Emergency Contact:
Phone:


Student Name:
Student Address:
City:     State:     Zip:
Date of Birth mm/D/YR:
Name of School:
Grade:
Student Email:


Class Name
Room
Date
Time
Princess Camp TBDJune 26-299-11am
Dance Camp TBDJune 26-29 12-3pm
Summer Nights (Age 8-11) - Week 1 1 July 10-13 4-6:30pm
Summer Nights (Age 8-11) - Week 2 1 July 17-20 4-6:30pm
Summer Nights (Age 10-14) - Week 1 2 July 10-13 4-9:00pm
Summer Nights (Age 10-14) - Week 2 2 July 17-20 4-9:00pm
Summer Nights (Advanced dancers 13+) - Week 1 3 July 10-13 5:30-8:30pm
Summer Nights (Advanced dancers 13+) - Week 2 3 July 17-20 5:30-8:30pm
The Intensive - Week 1 1 or 2 Aug 7-11 3:30-10:00pm
The Intensive - Week 2 1 or 2 Aug 14-18 3:30-10:00pm


General Liability Waver

Students of Michelle Latimer Dance Academy (MLDA) or parent/legal guardian of student if under 18, understands and agrees that in participating in any dance classes, rehearsals or performance there is a possibility of physical injury. Student or parent/guardian agrees, therefore, to assume all risks of any such injury which might occur during any and all MLDA classes, rehearsals and performances. Student or parent/guardian exempts, releases and indemnifies MLDA, its owner, guest artists and faculty members from any and all liability claims, demands or cause of action whatsoever from any damage, loss or injury to student, parent/guardian, family member or personal property which may arise out of, or in connection with participation in any activities conducted by MLDA. I understand and agree to the terms set forth in this Liability Waiver.


I understand that tuition is considered late after the 5th of each month. I understand that a late fee of $20.00 or 15% of my outstanding balance (whichever is greater) will be automatically added to my account after the 12th of each month.

Yes, I've read and agree to the terms and conditions.


Please use the space below for any
questions you may have.







Parent Signature:* Date:


If you are registering for a class that requires teacher recommendation, this registration will hold your dancer's place in the class.
However, registration cannot be finalized until the dancer takes the class and is given teacher approval to register.