Box 2244

Lac La Biche, AB T0A 2C0 2010 - 2011

Student Last Name_____________________________ First Name________________________________

Birth Date Day________ Month________ Year________ Age as of Dec. 31st/10________

Mailing Address_______________________________________________Postal Code________________

Home Telephone#________________________ Email address___________________________________

Mother’s Name________________________ Telephone (H)__________ (W)__________ (C)__________

Father’s Name_________________________ Telephone (H)__________ (W)__________ (C)__________

In case of Emergency please contact: Name____________________ Telephone______________________

AHC#____________________________ Name of School_______________________________________

Medical Conditions (asthma, allergies, previous injuries etc)______________________________________

______________________________________________________________________________________

I am willing to be a phone parent for my child’s class: __________

Classes potentially being offered this year: Ballet (6 & up), Pointe/pre-pointe, 2nd ballet class (Jr 5 & up),
Ballet Performance class (Jr 5 & up), Pre-Primary Ballet (3-5), Ballet for Dummies, (12 to Adult), Modern,
Lyrical(9+), Tap (age 6+), Jazz (6+), Jazz Funk (15 & up), Tap/Jazz/Ballet Combo (ages 3-5), Creative
Movement (3-5), Musical Theatre (3-adult), Hip Hop (6 & up), Boys Hip Hop (6-adult), Adult Hip Hop, Hip
Hop in Heels (16yrs – Adult), Adult Beginner Tap, Lebanese(4 to adult – adult class non-performing), Gyminy
Crickets(18mths – 3 years with parent participating), Romper Roos (3-5), Tech Class, Multi-discipline Adult
Class (see 2010-2011 Class List for descriptions)

Please list each class your child would like to be registered for and their experience in that discipline
Class Name (ballet, tap, jazz, hip hop, 2nd ballet etc) Previous Experience in discipline registering for only

Other previous dance experience (please list # of years for each discipline)___________________________

_______________________________________________________________________________________

**Classes will be scheduled: instructional time and registration numbers permitting. All ages are as of
December 31st **
 ANNUAL INSTRUCTION FEES PER STUDENT/PER CLASS:
Fees postmarked by September 1st Before September 1st After September 1st
30 minute class $105 $120
45 minute class $160 $175
1 hour class $210 $225
1.5 hour class $315 $330
2 hour class $420 $435

THIS FORM, PAYMENT, AND ALL POSTDATED CHEQUES MUST BE RECEIVED

ON OR BEFORE SEPTEMBER 1st TO QUALIFY FOR THE DISCOUNTED RATES

Calculation:

Fee for class(s)

First Class (most expensive class) Full Price $__________
Second Class (2 n d most expensive) 15% discount $__________
Third Class (3 r d most expensive) 15% discount $__________
Fourth Class and any additional classes $100 each $__________
*see pg 3 for calculation help* Total for all classes $__________

Costume Deposit: Total # of classes x $50 deposit = $__________

Family Membership fee ($5 for club voting privileges) $ __5.00____
TOTAL $ __________

Option 1 – one payment (cheque/money order) in full, dated by September 1 s t , 2010.

Total $ Cheque #

Option 2 – Two payments – One cheque/money order in half the amount da ted by September 1 s t ,
2010. One cheque/money order in half the amount, dated February 1 s t , 2011
September $ Cheque #
February $ Cheque #

Option 3 – Eight payments each for one-eighth the amount, dated the first day of each month
(September 1 s t , 2010 through to April 1 s t , 2011)
MONTH CHEQUE # MONTH CHEQUE #
September $ January $
October $ February $
November $ March $
December $ April $
Once Registrations are entered by the Treasurer, invoices will be issued for any outstanding or credit amoun t

DON’T FORGET to include the following separate, deposit cheques: (p lea se w rit e you r ch ild ’s name on the cheque )
1. 2 Fundraising commitment cheque of $50 each, undated cheq # ’s ___________
2. Volunteer commitment cheque of $50, undated cheq # ______________

**Please let us know if you would prefer us to just cash any of the volunteer/fundraising cheques**
 ----------------IMPORTANT WAIVER BELOW------------------
I understand that:
1. The Lac La Biche Dance Society is not responsible for any injuries that may occur during class.
2. As a parent, I will respect and not interfere in any way with:
a. The instructor’s placement of my child in accordance to their ability
b. The instructor’s decision as to which students may participate in festivals
c. The instructor or the executive members and follow proper procedure should any issues arise, by
initially contacting the appropriate dance representative
3. As a parent, it is essential to encourage my child to follow the rules and guidelines of the dance society, as
well as ensure that my child has the proper dance attire and shoes for each class.
4. That no dance fees will be refunded after September 30, 2010.
5. Costumes, once ordered, must be paid in full prior to release to dancers/parents.

(please ) I agree that the Lac La Biche dance society may use dancer photos in promotional materials and
advertisements.

My signature below indicates that I have read this waiver and the
What to Expect When You’re Dancing Handbook and agree to the provisions.

Signature: _______________________________________ Dated: ___________________________________

Calculation Help!
Length of class Before September 1st After September 1st
30 minute class with 15% discount $89.25 $102.00
45 minute class with 15% discount $136.00 $148.75
1 hour class with 15% discount $178.50 $191.25
1.5 hour class with 15% discount $267.75 $280.50

Office Use Only:

Registration Fee
Costume Deposit
Membership fee
2 Fundraising Cheques
Volunteer Commitment Cheque
Registration form signed
Handbook Agreement signed
Camcorder Agreement signed
Receipt Written
Entered into Computer