Student’s full name______________________________ (nickname)_______________
age___ date of birth____________
Address__________________________________City___________________ Zip_____________
home phone
_______________________ work phone _______________ Cell _________________
Bill to: Name ____________________________________________________________________
Address
(if different from above)______________________________________________ Zip_____________
Phone
number
School_________________________ Grade_____Hours ____________ Health Problems__________________________
Father’s Name ____________________________Profession_________________ Phone number_____________________
Mother’s Name ___________________________ Profession_________________ Phone
number____________________
Parents email
address: ____________________________________________
Previous Dance Experience: (not necessary for former students) Length of Study (number of years) and type of dance? (Ballet, Jazz, Tap)
Ages 3,4,5 & 6_____________________________
Ages 7-11 _____________________________________
Ages 12 – up ____________________________
Where? _____________________________________________________________________________
Please mark the
following:
Age Group Desired Course Number of Classes
|
3
|
Creative
Movement
|
|
|
4 & 5
|
Pre-Ballet
& Tap
|
|
|
6
|
Pre-Ballet and
Jazz
|
|
|
7-18
|
Ballet
|
|
|
7-18
|
Jazz
|
|
|
7-18
|
Tap
|
|
|
7-18
|
Hip-Hop
|
|
|
12-18
|
Modern
|
|
| 12-18 |
Lyrical |
|
Ballet-Pointe* will be at Faculty discretion.
*Class placement
is according to age and ability. If you have a work schedule or
existing commitments that
need consideration,
please list on reverse side of this registration.
Note: Please enclose $20.00 registration fee ($25.00 after June 30th). Check are payable to the Academy
of Dance Arts,
Inc.
Parent’s
Signature_______________________________________________
Academy of Dance Arts, Inc.
103 S. Hawthorne Rd.
Winston Salem, NC 27103
Dear Parents,
During the past several
years, it has come to our attention that there are several potential problem
areas at our school. Some children ride
the bus to the Academy from school and spend several hours on the premises. Our
staff is unable to monitor the comings and goings and behavior of our students
at any time other than during official class time. For this reason, it is necessary for us to
clearly state our position to you.
Academy of Dance Arts,
Inc. is not liable for and is hereby released from any injuries, claims or
damages resulting from any injury sustained by your child or by you on or about
the school premises, or any other place of rehearsal or performance. Further, Academy of Dance Arts, Inc. does not
stand in loco parentis to your child and is not responsible for any
injuries sustained by your child outside the premises of the school. You, the parent, are solely responsible for
the safe and appropriate delivery and pick-up of your child to and from the
school.
ACADEMY
OF DANCE ARTS, INC.
Wanda
Moore Plemmons, Owner/Director
I hereby certify my
acceptance of the above terms of my child’s enrollment in the Academy of Dance
Arts, Inc.
Name of Child
(Children) Parent/Legal Guardian
Date of Birth (dates) Address
___________________________________________________