Lighthouse Academy of Dance
Registration 2008
Name: ................................................................ Age (if under 18): ..........
Date of birth: ....................................... Phone #: ..................................................
Name of parent(s): ............................................
Address: ....................................................................................................................
E-mail: .........................................................................................................................
Emergency Contact Name: ........................................ Phone #: ..............................
Medical details (e.g. allergies, asthma): ..................................................................
Previous dance styles studied & level: ...................................................................
Ballet (Grade ..... ) Jazz/hop Celtic Musical Theatre
Tap Homeschool Dance Contemp/Modern ...................................
Classes: Please circle classes that you would like to take.
Adult Classes: Tap Jazz hop Ballet Celtic Contemp/Modern
Preschool: Ballet Ballet & Tap Dance combo
I enclose the registration fee of $25 (early bird $15 by 20th June), costume deposit of $30 per class exam deposit of $50, if applicable, and cheques/cash (to Lighthouse Academy of Dance) for the annual fees x 1 OR monthly x 10, OR termly x 3 (circle which applies) for $........... x .....
Another class may be substituted at the discretion of the Principal to make up for a missed class due to illness/circumstance.
In the event of withdrawal from a class, a full month's notice MUST be given or the next term's fees will become payable. The term should be completed. Term fees will NOT be refunded unless agreed by the Principal due to extenuating circumstances. An annual commitment is expected for most classes.
The withdrawal of a student after Christmas may result in a re-choreography fee
becoming payable to the withdrawn student/parent. Costume fees cannot be refunded
after December as materials and costumes will have been already ordered/bought.
I also understand that the studio is not liable for injury or accident to individual
students. Students will be advised in safe practice.
I also agree to images of myself/my son or daughter being used for promotional purposes only.
Signed, ........................................
(Parent/Guardian/Student 18+)
AGREEMENT please read and sign below