ROBERT MANN DANCE CENTRE, INC

ROBERT MANN DANCE CENTRE, INC. REGISTRATION APPLICATION PLEASE PRINT CLEARLY

YEAR___________________

FAMILY NAME ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ADDRESS________________________________________________________________________________________ CITY________________________STATE_______________ZIP CODE_______________________________________ HOME TELEPHONE NUMBER:

___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___

CELL TELEPHONE NUMBER:

___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___

EMERGENCY TELEPHONE NUMBER:

___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___

E-MAIL ADDRESS (PLEASE PRINT CLEARLY) __ __ __ __ __ __ __ __ __ __ @__ __ __ __ __ __ __ FATHER’S FIRST NAME___ ___ ___ ___ ___ ___ ___ ___ MOTHER’S FIRST NAME___ ___ ___ ___ ___ ___ ___ ___ FAMILY MEMBERS: ST

#1 FIRST NAME__ __ __ __ __ __ __ __ __ __ __ DATE OF BIRTH___ /___/ ______ AGE AS OF AUGUST 31 _____ THIS IS THE START OF MY_____ YEAR OF DANCE AND THE ____ YEAR AT THE ROBERT MANN DANCE CENTRE I CANNOT MAKE CLASS ON: PLEASE CHECK: MON____TUE____WED____THU____FRI____SAT____ I WISH TO ENROLL IN THE FOLLOWING CLASSES: (MINIMUM AGE 7) BALLET___ POINTE___ TAP ___ LYRICAL/COMTEMP___ ACROBATICS___ COMPANY TAP ___

JAZZ ___ COMPANY JAZ___

HIP HOP ___ ZUMBA___

ST

TINY TOTS DANCE (1.6-2.6 YRS OLD) ___ 1 STEPS DANCE (2.6-3.6 YRS OLD) ___ COMBINATION DANCE CLASS (3.6-6.0 YRS OLD) ___ YOUNG DANCERS PROGRAM -2 HRS TAP/JAZZ CLASS___ ST

#2 FIRST NAME__________________________ DATE OF BIRTH_____/_____/_____ AGE AS OF AUGUST 31 _____ THIS IS THE START OF MY_____ YEAR OF DANCE AND THE ____ YEAR AT THE ROBERT MANN DANCE CENTRE I CANNOT MAKE CLASS ON: PLEASE CHECK: MON____TUE____WED____THU____FRI____SAT____ I WISH TO ENROLL IN THE FOLLOWING CLASSES: (MINIMUM AGE 7) BALLET___ POINTE___ TAP ___ LYRICAL/COMTEMP___ ACROBATICS___ COMPANY TAP ___

JAZZ ___ COMPANY JAZ___

HIP HOP ___ ZUMBA___

ST

TINY TOTS DANCE (1.6-2.6 YRS OLD) ___ 1 STEPS DANCE (2.6-3.6 YRS OLD) ___ COMBINATION DANCE CLASS (3.6-6.0 YRS OLD) ___ YOUNG DANCERS PROGRAM -2 HRS TAP/JAZZ CLASS___ ST

#3 FIRST NAME__________________________ DATE OF BIRTH_____/_____/_____ AGE AS OF AUGUST 31 _____ THIS IS THE START OF MY_____ YEAR OF DANCE AND THE ____ YEAR AT THE ROBERT MANN DANCE CENTRE I CANNOT MAKE CLASS ON: PLEASE CHECK: MON____TUE____WED____THU____FRI____SAT____ I WISH TO ENROLL IN THE FOLLOWING CLASSES: (MINIMUM AGE 7) BALLET___ POINTE___ TAP ___ LYRICAL/COMTEMP___ ACROBATICS___ COMPANY TAP ___

JAZZ ___ COMPANY JAZ___

HIP HOP ___ ZUMBA___

ST

TINY TOTS DANCE (1.6-2.6 YRS OLD) ___ 1 STEPS DANCE (2.6-3.6 YRS OLD) ___ COMBINATION DANCE CLASS (3.6-6.0 YRS OLD) ___ YOUNG DANCERS PROGRAM -2 HRS TAP/JAZZ CLASS___ I AM INTERESTED IN: PLEASE CHECK ONE OR MORE: ____WEEKDAY MORNINGS CLASSES (10AM-12NOON) ____WEEKDAY EARLY AFTERNOON CLASSES (1-3:30PM) ____WEEKDAY AFTERNOON CLASSES (3:30-6:30PM) ____WEEKDAY EVENINGS CLASSES (7:30-9:30PM)

____ SATURDAY MORNING CLASSES 9AM-12PM ____ SATURDAY AFTERNOON CLASSES 12PM-5PM

DANCE HISTORY: LIST SUBJECTS – YEARS OF TRAINING – NAME OF SCHOOL _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ I WOULD LIKE TO BE CONSIDERED (COMPANY MEMBERSHIP REQUIRED) FOR: SOLO ROUTINE:

YES_____ NO_____

DUO/TRIO ROUTINE:

YES_____ NO_____

SPECIAL GROUP:

YES_____ NO_____

COMPANY MEMBERSHIP:

YES_____ NO_____

FOR OFFICIAL USE ONLY: NAME OF STUDENT__________________________ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ NAME OF STUDENT__________________________ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ NAME OF STUDENT__________________________ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ DAY__________TIME__________ SUBJECT__________STUDIO_____ ANNUAL REGISTRATION FEE $25.00 PER STUDENT (NON REFUNDABLE) DATE PAID _______________ AMOUNT PAID $_______________ RECEIPT NUMBER_______________ PLEASE NOTE: Upon signing this Registration Application you hereby signify that you have read and agree to abide by the rules governing students at the Robert Mann Dance Centre, Inc. ______________________________________ Signature of Student or Parent/Guardian for Students under the Age of 18 STUDIO CHECK LIST: _____ DESK TUITION CARD MADE _____ ENTERED ON QUICKEN _____ ENROLLED IN CLASSES

_____ FILE CARD MADE _____ ENTERED ON DATABASE _____ ENTERED ON CONSTANT CONTACT