Registration Please contact us to inquire about class pricing and registration fees. If you are registering more than one child, please complete a separate form for each. TODAY'S DATE * STUDENT INFORMATION NAME * First Name Last Name AGE * BIRTH DATE * MM DD YYYY MEDICAL INFORMATION * Please list ALL medical conditions that we should be aware of. If none, please enter "NONE" PARENT/GUARDIAN INFORMATION NAME * First Name Last Name PHONE # (Cell) * (###) ### #### STREET ADDRESS * Address 1 Address 2 City State/Province Zip/Postal Code Country EMAIL ADDRESS * YOUR RELATIONSHIP TO THE STUDENT * HOW DID YOU HEAR ABOUT US? Which session are you interested in registering for? 2023-2024 Dance Season Notice: Classes are broken up by level. Please contact us prior to registering online for proper class placements and class requirements. CLASS SCHEDULE (PLEASE SELECT EACH CLASS YOU ARE REGISTERING YOUR CHILD FOR) MONDAY CLASS 5:00pm - 6:00pm: TURNS & LEAPS (Studio A) 5:15pm - 6:00pm: Tapping Tots (Studio B) 6:00 pm - 7:00pm: CONTEMPORARY (Studio A) 6:00pm - 7:00pm: Tap (Studio B) 7:00 pm - 8:00pm: HORTON (Studio A) 7:00pm - 8:00pm: PRE-POINTE (Studio B) TUESDAY CLASSES 4:00pm - 5:00pm: POINTE (Studio A) 5:00pm - 6:00pm: ACRO 2B (Studio A) 5:00pm - 5:45pm: CREATIVE MOVEMENT (Studio B) 6:00pm - 7:15pm: BALLET 2B (Studio A) 6:00pm - 7:00pm: INTRO TO BALLET (Studio B) 7:15pm - 8:15pm: HIP-HOP 1B (Studio A): FULL! 7:15pm - 8:15pm: BALLET 2A (Studio B) WEDNESDAY CLASSES 5:00pm - 6:00pm: HIP-HOP 2 (Studio A) 5:30pm - 6:15pm: ACRO 1A (Studio B) 6:15pm - 7:30pm: BALLET 3 (Studio A) 6:15pm - 7:00pm: HIP-HOP 1A (Studio B) 7:00pm - 8:00pm: HIP-HOP 1B (Studio B) THURSDAY CLASSES 5:00pm - 6:00pm: ACRO 3 (Studio A) 5:00pm - 6:00pm: ACRO 1B (Studio B) 6:00pm - 7:00pm: BALLET 2A (Studio A) FULL! 6:00pm - 7:00pm: BALLET 1A (Studio B) 7:00pm - 8:00pm: JAZZ 1B (Studio A) SATURDAY CLASSES 9:15am - 10:00am: MY GROWN- UP & ME (Studio B) 10:00am - 11:00am : BALLET 1B (Studio A) 10:00am - 10:45am : ACRO 1B (Studio B) 11:00am - 12:00pm: JAZZ 1A (Studio A) 11:15am - 12:00pm: CREATIVE MOVEMENT (Studio B) 12:00pm - 3:30pm: COMPANY (Studio A) EMERGENCY CONTACT INFORMATION Please provide the information below for the person you would like us to contact in the event of an emergency while your child is in dance class and we are not able to reach you. NAME * First Name Last Name CONTACT NUMBER * (###) ### #### RELATIONSHIP TO THE STUDENT WAIVER AGREEMENT & SIGNATURE I hereby release Monarch Dance Academy, Aliya Anderson, teachers and students in any capacity for any liability due to injuries that may occur as a result of participation in any and all dance classes at Monarch Dance Academy, or any event associated with Monarch Dance Academy. I understand that participation in this class will involve rigorous activity. I am fully aware of any & all personal medical conditions. hereby certify that my dancer is physically capable and willing to participate in the enrolled class. Registration fees are non-refundable and non-transferable. Tuition is also non-refundable and non-transferable once a tuition period has started. PARENT/GUARDIAN SIGNATURE * MEDIA RELEASE FORM I hereby grant Monarch Dance Academy (hereinafter "MDA"), its agents, employees or other assignees permission to use my likeness in photograph, video, and/or audio recording in any and all of its publications or broadcasts, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of MDA and will not be returned. I hereby irrevocably authorize MDA to edit, alter, copy, exhibit, publish or distribute this photograph, audio, and/or video recording for purposes of publicizing programs affiliated with MDA or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph, video and/or audio recording. I hereby hold harmless and release and forever discharge MDA from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may acquire by reason of such authorization. I am at least 18 years of age and am competent to contract in my own name. I have read this release before I signing below and I fully understand the contents, meaning, and impact of this release. SIGNATURE DATE PRINTED NAME DATE If the person signing is under age 18, there must be consent by a parent or guardian, as follows: I hereby certify that I am the parent or guardian of named above, and do hereby give my consent without reservation to the foregoing on behalf of this person. Parent/Guardian's Signature Date Thank you! After hitting submit, you will be redirected to our policies/dress code page.Please contact us to inquire about class pricing and registration fees.
