Marie Ann Longlade School of Dance Inc.
A Registered Educational Institution
Family Operated Business since 1965
1650 Dundas St. E. Suite 205
on Dundas between Dixie & 427
Mississauga, Ont. L4X 2Z3
www.marieannlongladeschoolofdance.com email: malonglade@rogers.com
Phone 905 276- 7471
Fax 905 822 -6386
We TEACH the LOVE of DANCE
REGISTRATION FORM 2009-2010 45th Season. (posted rev. June 16th, 2009)
REGISTRATION FEE OF $25.00 PER FAMILY MUST ACCOMPANY THIS FORM Non-Refundable
Please Print ClearlyDate:_______________________________
Date:_______________________________Student’s Name _________________________________________________________________________________
Parent’s/Guardian’s Name _________________________________________________________________________
Address ___________________________________________________________________________________________________________________________
City ____________________________________ Postal Code __________________________ Home Ph.# (________)_________________________
Postal Code __________________________ Home Ph.# (________)_________________________Cell Ph. # ( ______)_______________________ Bus. Ph. # ( )______________________ email _______________________________________
Bus. Ph. # ( )______________________ email _______________________________________Date of Birth ________ _________ _____________ Age ________
(DAY) (MONTH) (YEAR)
Doctor’s Name ___________________________________ Doctor’s #________________________Emg. Phone_______________________________
Doctor’s #________________________Emg. Phone_______________________________Allergies______________________________________________________________________________
!!!! NO PEANUT PRODUCTS ALLOWED AT THE STUDIO -- !! NO GUM CHEWING ALLOWED
Please leave your pets at home. Thank you.
Please DO NOT bring any valuables to the studio.
Started Dance at this studio _________ ________
(month) (year)How did you hear about the studio?? ________________________________________________________________________________________________
Previous dance training _____________________________________________________________________________________________________________
Previous dance examinations w/Organization/Association __________________________________________________________________________________________________________________________________
INTERESTED IN DANCE EXAMINATIONS Yes_______ No____________
No____________INTEREST IN COMPANY/COMPETITION - (by invitation - Ballet Mandatory ________ Current Member _____
PLEASE MARK PREFERENCE: Evening Classes __________ Saturday Classes____________
PLEASE MARK YOUR CHOICE OF COURSE/S (8 & up all classes .60/90 minutes)
Kinderdance (2-3yrs-30min)_______Pre School (Ballet Based 3-5 yrs -45min) _______ Pre School Combo (Ballet & Tap 4-5yrs. .75 min.) ______
Pre School (Ballet Based 3-5 yrs -45min) _______ Pre School Combo (Ballet & Tap 4-5yrs. .75 min.) ______Beg Ballet (5-7 yrs-50min)________Classical Ballet (8 & up)_______ Cecchetti Ballet_______
Classical Ballet (8 & up)_______ Cecchetti Ballet_______ Pointe (12yrs)_____ Tap (4 up) ________ Jazz (6 up)_______
Tap (4 up) ________ Jazz (6 up)_______Acrobatic ______ Hip Hop (9 up)__________ Special Needs Dance _______
Hip Hop (9 up)__________ Special Needs Dance _______**Adult Ballet_______**Adult Tap_______ **Adult Jazz_______ **Adult Hip Hop ____________
**Adult Tap_______ **Adult Jazz_______ **Adult Hip Hop ____________ NIA ________ Pilates ________ Singing/Voice___________Yoga_________Other Classes_________
Pilates ________ Singing/Voice___________Yoga_________Other Classes_________++ SPECIAL CLASSES OFFERED TO PREPARE FOR EXAMINATIONS
++ Imperial Society of Teachers of Dance – Cecchetti Ballet Method Grade Level_______________
Grade & Standard Examination Classes require a minimum of 3 classes per wk
++ Canadian Dance Teachers Association Examination Classes
(Additional classes prior to examination will be required)
Ballet Grade_______________Tap Grade ____________________Jazz Grade _______________
++ Billed Separately ++Company (Separate registration form) **1st installment non-refundable
** No Credit or Refunds.$30.00 administration fee for payments that are declined.
** 4% processing fee added to all credit card payments. VISA/AMERICAN EXPRESS
* $5.00 late fee will be applied to your account..
** Make-up classes available
Costume Deposit due October 1st. cheques/cash only Balance due in May-payable to Marie Ann Longlade
Tuition - Cheques payable to: MARIE ANN LONGLADE SCHOOL OF DANCE
Cash (Visa/American Express + 4%) accepted. No Debit payments.
Signature of Parent/Guardian __________________________________________________________
Please sign the waiver below. Thank you.
WAIVER:
1.I hereby give permission to have staff arrange for any emergency medical care including hospitalization if necessary. In all instances where children are involved, attempts will be made to contact parent or guardian first. I release the Marie Ann Longlade School of Dance Inc. from all claims arising from participation in any activity.
I hereby give permission to have staff arrange for any emergency medical care including hospitalization if necessary. In all instances where children are involved, attempts will be made to contact parent or guardian first. I release the Marie Ann Longlade School of Dance Inc. from all claims arising from participation in any activity. It is understood and agreed that the student and their parents or guardian hereby release Marie Ann Longlade School of Dance Inc. from any and all damages sustained in consequence of loss, injury or damage to any person or property arising from any cause what so ever and from any or all actions, causes of action, claims and demands of any nature.
2.The undersigned on behalf of the students registered, authorize Marie Ann Longlade School of Dance Inc. the use of ir pictures or videos for advertising purposes and/or on the web site www.marieannlongladeschoolofdance.com. The Web site is password protected.
The undersigned on behalf of the students registered, authorize Marie Ann Longlade School of Dance Inc. the use of ir pictures or videos for advertising purposes and/or on the web site www.marieannlongladeschoolofdance.com. The Web site is password protected.3. In addition I fully understand that Marie Ann Longlade School of Dance Inc and our faculty are not liable for any personal injuries, loss or damages sustained while attending class or events.
NOTE: Cancellations: All classes are subject to cancellation if there are insufficient registrations. We will notify you, as soon as possible, if a decision on class cancellation/s have been made. Class schedule may also need to be changed. Thank you. The first installment is non-refundable. $30.00 service charge for any declined payments.
CLASS/ES WILL BE CANCELLED IN SEVERE WEATHER CONDITIONS. CHECK THE WEB SITE AND/OR ANSWERING MACHINE. THANK YOU.
Additional Classes - Note- *CDTA Ballet &/or Tap, Jazz Examination classes (approximately 10-12 extra classes each grade) This does not guarantee that they will be ready for the examination. It is our philosophy to wait, if the student is not ready 2 weeks before the examination. The certificate will remain at the CDTA office until the student takes more time to prepare for the examination.
Student’s Name ________________________________________________________________________
Signature of Parent/Guardian______________________________________________________________
Dated ______________________________________________________________________________
rev. June 16, 2009
