One form per dancer. Are you registering more than one dancer total? No Yes How many total. Last Name: Dancer s Name: Birthdate mm/dd/yy

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Luke Reed
5 years ago
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1 CHARLEE S ELITE SCHOOL OF DANCE Cl llaassss Reeggi iisst traat ti iioonn One form per dancer. Are you registering more than one dancer total? No Yes How many total Last Name: Dancer s Name: Birthdate mm/dd/yy Parent(s) or Legal Guardian(s) Responsible: Mailing Address: City: Zip: Home Phone: Cell Phone: Work Phone: Address: 2 nd Address: Emergency Contact Name: Phone 1: Phone 2: Allergies: By Initialing here you will allow CESOD to release your name, phone# and address on a class/contact list. (This information WILL NOT be released to anyone outside the studio) I,, the parent or legal guardian of, herby give permission for my child to participate in all activities with CESOD. I agree that we will comply with CESOD s rules, policies and procedures as they exist. I understand that dance instruction, performance, and related activities involve some risk of injury or harm, and I assume all liability (whether for injuries or otherwise) arising out of my child s participation in such activities. I agree to indemnity and to hold CESOD and its owners and employees harmless from and against any and all liability, damages, costs, claims and expenses incurred by any of them in connection with my child s participation in any CESOD activity. IF CESOD determines than an injury suffered by my child requires medical attention, I understand that CESOD will make every reasonable effort to contact me. I herby give permission for emergency medical treatment to be given to my child by providers chosen by CESOD. By signing below, I further bind myself, my child and our respective heirs, executors, administrators and assigns. Parent/Legal Guardian Signature: date Class Name/Description Ages Day Time Movin 2 The Music Preschool Ballet/Tap Preschool Ballet/Tap Monthly Tuition 2-3 Wednesday 4:40-5:00pm $ Monday 4:30-5:00pm $ Tuesday 4:45-5:15pm $ Wednesday 5:00-5:30pm $ Monday 4:40-5:25pm $ Tuesday 5:15-6:00pm $54.06 Register Office Use

2 Preschool Ballet/Tap Kinderdance Kinderdance Pink capezio lily Ballet Shoes 212c Level 1- Includes Ballet and Tap Level 1- Includes Ballet and Tap Level 2- Includes Ballet, Tap & PreJazz Level 2- Includes Ballet, Tap & PreJazz Level 3- Includes Ballet, Tap & Jazz Ballet/Tap/Jazz in Recital Level 4- Includes Ballet, Tap, Jazz & PrePointe Ballet/Tap/Jazz in Recital Demi pointe shoe 116/18 Level 5- Includes Ballet, Tap, Jazz & Pointe Ballet/Tap/Jazz/Pointe in Recital Black fluid tap shoes cg17 Black cg30 jazz shoes & pointe shoes Level 6- Includes Ballet, Tap, Jazz & Pointe Ballet/Tap/Jazz/Pointe in Recital Caramel cg30 jazz shoes & pointe shoes Pom Class 1 Pom Class 2 Pom Class Wednesday 5:30-6:15pm $ Monday 5:00-6:00pm $ Thursday 5:00-6:00pm $ Tuesday 5:00-6:00pm $ Wednesday 6:15-7:15pm $ Monday 6:00-7:15pm $ Tuesday 6:00-7:15pm $ Monday 4:45-6:15pm $ Tuesday 6:00-8:00pm $ Monday 6:15-8:30pm $ Tuesday 6:15-9:15pm $ Tuesday 5:00-5:45pm $ Tuesday 5:45-6:30pm $ Tuesday 7:30-8:30pm $63.60

3 Pom Tumbling Class Hip Hop 1 Hip Hop 2 Hip Hop 3 Tiny Tots Tumbling Tumbling 1 Tumbling 2 Tumbling 3 Tumbling 4 Tumbling 5 Hair must be off neck in Tumbling 6 Hair must be off neck in Tumbling 7 Hair must be off neck in Tumbling 8 Hair must be off neck in APPROVAL FROM CHARLEE- Opening/Finale Shoes TBD Advanced Ballet Technique Junior Tuesday 6:30-7:30pm $ Thursday 6:00-6:30pm $ Thursday 6:30-700pm $ Thursday 7:00-7:45pm $58.36 Beginning class Charlee Approval +13 Monday 5:30-6:00pm $54.06 Monday 6:00-6:45pm $54.06 Monday 4:25-5:25pm $68.90 Thursday 4:30-5:30pm $68.90 Thursday 6:30-7:30pm $68.90 Thursday 5:30-6:30pm $68.90 Monday 7:45-8:45pm $68.90 Thursday 7:30-8:30pm $68.90 Monday 6:45-7:45pm $68.90 Thursday 9:00-10:00pm $63.60 Junior TBD TBD $74.20

4 Advanced Ballet Technique Teen Advanced Ballet Technique Senior Teen TBD TBD $74.20 Senior Monday 8:00-9:30pm $74.20 ELITE EDGE TEAM CLASSES AUDITION ONLY Petite Edge Junior Edge Pre-Teen Edge Black fluid tap shoe cg17 Pointe shoes must be ok d by Charlee Teen Edge Bloch tan pulse jazz shoes & pointe shoes Senior Edge Bloch tan pulse jazz shoes & pointe shoes Elite Edge Hip Hop Petites/Juniors Elite Edge Hip Hop Pre-Teen Elite Edge Hip Hop Teen/Senior Monday 5:30-6:45pm $74.20 Monday 6:45-8:30pm $90.10 Tuesday 4:45-7:00pm $ Wednesday 3:30-6:00pm $ Tuesday 7:00-10:00pm $ Thursday 6:00-6:30pm $53.00 Thursday 7:00-7:30pm $53.00 Thursday 8:15-9:00pm $58.36 Automatic debit/credit card payment is available. Please check this box if you are interested. (MasterCard, VISA & Discover.) Costume Deposit $25.00 (26.50 with tax) $26.50 Recital Fee: single at $117.66, two at $ or family at $ (includes tax) $117.66/$206.70/$ Tuition Deposit (1 month of tuition payment): Invoice will be ed New Student One Time Ever Fee $25.00 (26.50 with tax) $26.50

5 I understand that tuition is due on the 1 st of every month and a $10.00 fee will be added to my account if this tuition is not paid by the 5 th of the same month. CESOD does not or mail monthly tuition invoices. I agree to notify CESOD in writing in the event that my dancer is unable to participate in the recital by October 1, 2018 in order to receive a refund of my recital fee. If this notice is not provided by this date, I will not get my recital deposit returned and I am financially responsible for costumes that are ordered for my dancer(s). If, for any reason, my dancer or tumbler needs to quit a class before the end of the dance season, I will fill out the Drop Form by the 1st of the prior month to avoid further tuition charges. In the event of a dancer receiving an injury which limits dancer s ability to participate in class/recital, there will be no refund of payments and monthly fees must be paid. If my account becomes 60 days past due, I understand that my dancer(s) or tumbler(s) will not be able to participate in class until my account balance is current. I understand contact about my account and classes will be via , I will make sure to update my information with CESOD and I am responsible for receipt of s. If my account becomes 90 days past due, I realize that it will be considered delinquent and it will be forwarded to a third party. Signature(s) below claim full financial responsibility for dancers account. Signature: Printed Name: Date: Accounts where more than one parent/guardian is financially responsible, all parties must sign to accept terms and conditions of payment. Signature: Printed Name: Date: Complete all areas of the fillable registration form and to DanceatCharlees@gmail.com --Your registration will be processed and an invoice will be ed back to the address listed on the registration form. --Payment is due upon receipt of the invoice. --Registration is not complete until both the completed registration form, and all registration payments have been paid in full. -- Registration is on a first come, first serve basis, dancers spots will not be held without fully completed registration/payment.

Classes offered for (ages 2-7) School year!!

Classes offered for (ages 2-7) 2017-2018 School year!! 1 ½-2 ½ Years Mommy & Me Wednesday-3:45-4:15pm Dina Monday- 9:15-9:45am Amanda Thursday- 9:15-9:45am Amanda Saturday- 9:45-10:15am Amanda Saturday-