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  Adult Hip Hop
 Tap/Ballet o Beginner
 Tap/Jazz o Advanced-Beginner
 Modern o Inter/Advanced
 Ballet  Adult Ballet
 Pointe  Adult Lyrical
 Hip Hop  Adult Jazz
 Tap o Beginner (Luigi Jazz)
 Musical Theatre o Inter/Advanced
 Jazz  Adult Tap
 Lyrical 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