CLOSED FOR MEMORIAL DAY WEEKEND

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Ernest Green
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1 DANCE DIMENSIONS PAC 2016 BALLROOM DANCE REGISTRATION DANCE (3262) Fax: PLEASE FILL OUT COMPLETELY! Today s Date: _ Student s Name (Please Print) Age: Date of Birth: Parents Names Home Address City Zip Home Phone Number Work Phone Number PARENT Cell Phone Number Emergency Contact Primary Phone Number Secondary Phone Number School District Address (Very Important!) How did you find out about Dance Dimensions? _ Ballroom & Latin Dance fees: **CLOSED FOR MEMORIAL DAY WEEKEND** Kid Ballroom & Latin Dance Program (9-17 years old) May 7 th June 18 th*, Every Saturday from 4-5pm No Registration Fee! Ballroom and Latin Dance $99 for 6 weeks 5% discount for siblings $94.05 for 6 weeks Adult Ballroom & Latin Dance Program (18+ years old) May 7 th June 18 th*, Every Saturday from 5-6pm ChaCha, Rumba, Salsa, Swing & Foxtrot Dance $99 for 6 weeks 1

2 POLICIES PAYMENT POLICIES Credit Card and cash only. No checks. Must be paid in full before April 30 th. There are no refunds for missed classes. Kids can do a make-up in our Academy technique classes. STUDIO POLICIES We offer a 5% discount on tuition for siblings All payments and fees are non-transferable and non-refundable. Enrollment forms must be filled out & signed by a parent in order for student to take classes. Pre-registration is required for the program Studio is not responsible for lost or stolen items. Please do not bring anything of value to the studio. Dance Dimensions reserves the right to change the schedule and/or cancel classes at any time. All classes and programs are subject to change and/or cancellation. Dance Dimensions is not responsible for students who leave the facility without supervision or permission form. Make sure to submit form found in this Registration Packet. Dance Dimensions reserves the right to dismiss or refuse classes to anyone who does not comply with our policies or who otherwise in our sole judgment disrupts the harmony and/or reputation of the studio. Please do not ask to be the exception to any of the studio policies! I hereby release Dance Dimensions and all class and performance locations, as well as their owners, agents, employees, volunteers, contractors and successors, from liability. I agree to indemnify them for and hold them harmless from losses, suits, claims and demands of every kind and character arising out of and in conjunction with my Child s or my own participation in these classes. I recognize and acknowledge there are certain risks of physical injury, and I agree to assume the full risk of personal injuries, accidents, illnesses, death, damages and/or property loss that I or my minor child may sustain as a result of participating in any activities connected with or associated with Dance Dimensions programs, classes or private lessons. I hereby assign all rights to videotaping, photographs and sound recordings without limitation or compensation. I understand there will be no refunds for missed classes. I have read, understand and agree to abide by these policies: Parent/Adult Name (print): _ Dancer s Name (print): Parent/Adult Signature: Date: 2

3 MEDICAL RELEASE I am a current 2016 DD student: use my Medical Information on file. I, authorize Dance Dimensions Performing Arts Center to provide any attention necessary to my dancer,, in the event of a medical emergency, including but not limited to ice, bandages, Tylenol and transportation to a medical facility, if needed. Insurance Company Doctor s Name Doctor s Phone Number Allergies Date of last Tetanus shot _ Does your child have any current medical conditions? Print your name Relationship to dancer Signature ADD CLASSES Please Print! Fill out desired program below. STUDENT NAME KID/ADULT PROGRAM? 3

4 DANCE DIMENSIONS PERFORMING ARTS CENTER CREDIT CARD AUTHORIZATION Tuition Cost to be charged $ Use Credit Card on File? Payment Type (circle one): Visa Mastercard NO CHECKS! Cardholder s Name: Card # Expiration Date CVC code (3 numbers) Address where credit card is billed Cardholder Signature Today s Date Print Dancer s Name(s) Phone number address Note: This address will be used to confirm class changes, payments and other Dance Dimensions business. Please write legibly and choose the most appropriate address for this type of communication. Thank you! 4

5 DANCE DIMENSIONS PERFORMING ARTS CENTER POLICY ACKNOWLEGEMENT 2016 By initialing the statements below, I agree that I have read, understand and will abide by Dance Dimensions complete policy as detailed elsewhere in the Registration Packet. Initial each of the following summary statements, and sign and date at bottom. Tuition is non-refundable. There are no refunds, credits, or extensions given for missed classes. Dance Dimensions does not prorate for absences or vacation time. Dance Dimensions reserves the right to change or cancel classes at any time. Respectful behavior is expected at all times towards Dance Dimensions staff and fellow students. No food or drink allowed in the studios. Please eat snacks or lunches in the kitchen or in designated areas. Do not bring cell phones or gum into the studios. Dance Dimensions is not responsible for lost or stolen articles. Dance Dimensions assumes no liability for any injury sustained while participating in dance classes or any other studio activity, either at DDPAC or away. I release Dance Dimensions Performing Arts Center, its staff, management, owners, contractors and volunteers from any liability due to injury. Dance Dimensions reserves the right to dismiss or refuse classes to anyone who does not comply with our policies or who otherwise in our sole judgment disrupts the harmony and/or reputation of the studio. _ Parent s Signature Date _ Student s signature 5

6 DANCE DIMENSIONS PERFORMING ARTS CENTER WAIVER OF LIABILITY READ THIS DOCUMENT CAREFULLY BEFORE SIGNING. BY SIGNING THIS DOCUMENT YOU ARE LIMITING YOUR LEGAL RIGHTS. NAME OF PARTICIPANT This Release and Waiver of Liability is executed on this date of, 2016, by: if over 18) or If the participant is a minor, this document is to be signed by the minor s legal guardian (parent). By signing below, minor's legal guardian indicates that he or she understands that the use of I below refers to both the legal guardian and minor. I wish to participate in a dance class, rehearsal, dance party or other activity at Dance Dimensions Performing Arts Center (hereafter known as DDPAC ), either as part of DDPAC s programming or as a participant of a private studio rental of DDPAC facilities. As a condition of DDPAC agreeing to allow me to participate in such an activity, I hereby confirm and agree to the following: 1. I recognize that the activity of the type I intend to participate in at DDPAC requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. 2. I understand that it is my responsibility to consult a physician prior to and regarding my participation in any activity I attend at DDPAC. I represent that I am physically fit and have no medical condition that would prevent my full participation in any such activity. 3. I understand that DDPAC is not liable for any injuries to any participant, dependent(s) or guest(s) or be subject to any claim or demand for injury or damages whatsoever, including, without limitation, those damages resulting from acts or negligence on the part of DDPAC, its owners, agents, instructors or employees. I, and on behalf of my executors, administrators, heirs, assignees and successors, do hereby knowingly and voluntarily forever waive, release, discharge and agree to indemnify and hold harmless DDPAC, its owners, instructors, employees, assignees and successors from all such claims, demands, injuries, damages, actions or causes of action for any injury or damage that I may sustain as a result of my participation in an activity anywhere within the confines of DDPAC. 4. DDPAC shall not be responsible to me, my dependents or guests for property damaged, lost or stolen in or surrounding DDPAC confines, including but not limited to clothing, cellphones, cash, credit cards, jewelry and any and all personal property brought to and/or left at DDPAC. 5. I agree to take full responsibility for any risks, injuries, loss or damages known or unknown which I incur, or may incur, as a result of participation in any activity at DDPAC. I DECLARE that I have fully read and understand this waiver and release prior to signing. I understand that I am waiving any right I may have to assert a claim against the Released Parties. X Date Dancer/Participant s Signature Age of Minor Print Name of Responsible Party X Date Responsible Party Signature 6

7 Keep This Page Welcome to Dance Dimensions Ballroom & Latin Dance Program 2016! Policies & Information BALLROOM & LATIN DANCE DRESS CODE Shoes: Jazz shoes or sneakers Clothing: Comfortable clothing to move in MEET OUR TEACHER: BRIAN FORTUNA Brian Fortuna is a multi-talented entertainer. He has starred in the hits of both the stage and television, including Dancing with the Stars, Strictly Come Dancing, and Burn the Floor. Brian s electrifying performances in Burn the Floor earned him a What s On Stage Award nomination for Best Newcomer During Strictly Come Dancing s 7th series, Brian and his celebrity partner danced their way to the semi-finals and earned a perfect score for their American Smooth and Viennese Waltz; the highest score for a Viennese Waltz in Strictly history. Brian has toured extensively as a principal dancer, performing at every major venue in both the United States and the United Kingdom. He performed the dual roles of dancer and host during the Dancing with the Stars tours in front of sold out audiences. His hosting talents captured the attention of ABC who chose Brian as series co-host for ABC s Dancing with the Stars Online Encore. In addition to his hosting, Brian also took on the roles of Lead Choreographer and Consulting Producer for Dancing on Wheels. This groundbreaking show premiered on BBC3 and paired disabled and able-bodied contestants in highlevel dance competition. The show had the highest premiere ratings for a documentary in BBC history. Reminders from your Registration Form: PARENT S MEDICAL AUTHORIZATION I authorize Dance Dimensions Performing Arts Center to provide any attention necessary to my camper in the event of a medical concern, including but not limited to ice, bandages, Tylenol/Motrin and transportation to a medical facility, if needed. In the event I cannot be reached in an emergency, I hereby give permission for hospital personnel to administer treatment they deem necessary, including hospitalization. LIABILITY RELEASE I hereby release Dance Dimensions and all class and performance locations, as well as their owners, agents, employees, volunteers, contractors and successors, from liability. I agree to indemnify them for and hold them harmless from losses, suits, claims and demands of every kind and character arising out of and in conjunction with my Child s or my own participation in these classes. I recognize and acknowledge there are certain risks of physical injury, and I agree to assume the full risk of personal injuries, accidents, illnesses, death, damages and/or property loss that I or my minor child may sustain as a result of participating in any activities connected with or associated with Dance Dimensions programs, classes or private lessons. I hereby assign all rights to videotaping, photographs and sound recordings, and authorize the reproduction, sale, copyright, exhibition, broadcast and distribution of such videotapes, photographs and recordings without limitation or compensation. MAKE UP DAYS AND ABSENCES I understand there will be no refunds, but I may have a scheduled make up within the same calendar month of a missed class, ONLY if I call and schedule. The only available make up class is technique. Make up days cannot roll over to the Fall program. PAYMENTS No checks accepted at any time. Students cannot participate unless balance is paid in full. Payment due at time of sign-up. No refunds No exceptions Classes & Schedule subject to change. Ph: DANCE (3262) Fax:

Master Class Intensive Week August 10 th 14 th $400/wk - $90/day - $45 class drop in $185-Ballet Classes Only $225-NonBallet Classes Only

Master Class Intensive Week August 10 th 14 th $400/wk - $90/day - $45 class drop in $185-Ballet Classes Only $225-NonBallet Classes Only DANCE DIMENSIONS PAC 2015 MASTER CLASS INTENSIVE REGISTRATION 818-999-DANCE (3262) Fax: 818-999-5298 PLEASE FILL OUT COMPLETELY! Today s Date: _ Student s Name (Please print) Age: Date of Birth: Parents