2008/2009 Registration Form

 

 

Student Name ____________________________________________ Age ____ Date of Birth ________

Address_________________________________________________ Home Phone ________________

Email: _________________________________________________________________

School District ______________________ Grade Entering ______ School _______________________

Parent/Legal Guardian(s): _______________________________ Phone __________________

                                              _______________________________ Phone ________________

Emergency Contact(s):      ______________________________  Phone __________________

                                               ______________________________  Phone__________________

Permission to administer first aid/CPR            Yes          No

Permission to transport                                   Yes         No

Circle the appropriate interest:

Tutoring    Dance Classes    Coaching    MUCAI Dance Group    RADS Club    Physical Training

Circle classes interested in:

   ____ Pre-School Ballet         _____ Contemporary                ______ Group Conditioning

   ____ Pre-School Tap            _____ Tap                                  ______ Personal Training                   

   ____ Ballet                              _____ Phunky Jazz

   ____ Pointe                             _____ Classical Jazz

 

List a personal strength: _________________________________________________________________

List a personal weakness: ______________________________________________________________

Special Needs, Health Concerns, Injuries in the last 2 years: ____________________________________________________________________________________

____________________________________________________________________________________

Tutoring Registrants:   

List academic strengths: ________________________________________________________________

                                       ________________________________________________________________

List academic weaknesses: _____________________________________________________________

                                             _____________________________________________________________

Dance Registrants:

Years of experience:     Ballet______    Pointe______   Tap_____    Jazz______   Contemporary_______  

                                      Theatre Dance ______   Hip Hop______   Performance _______

 

Fitness Registrants:

Level of Physical Exercise:  Very Active         Somewhat Active       Not Actively Exercising

 

Parent Signature _________________________________ Date _________________________

Students Signature (if over 18): _____________________________________ Date ________________