"A Judaic Dance and Arts Program for Women and Girls"
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"A Judaic Dance and Arts Program for Women and Girls"
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· CREATIVE
LEARNING INSTITUTE OF DANCE 23165
Timberlane Dr. Bchwd.
· Fill
out and send or submit to
teacher or staff member
Personal Info:
Students Name_______________________________________________________________
Date of Birth_________________M - F ____Age ____________________________
Students Name_______________________________________________________________
Date of Birth _________________M-F_________Age ________________________
School Attending____________________________________________________________
Parent/ Guardian Name________________________________________________________________
Address_______________________________________________________________
Cell Phone________________________Home Phone No________________________
Email (required)______________________________________________________________
Does your child have any allergies / or asthma ? Yes No
If
yes, please specify
________________________________________________________________________
Is
your child allowed full physical activity? Yes No
Explain_________________________________________________________________
Note any behavioral problem(s)___________________________________________________
Any
conditions or limitation we should now please explain:
________________________________________________________________________
Emergency Contact Info:
NAME _____________________________Phone No._______________________________
NAME_____________________________Phone No.________________________________
Students Dance Experience :
________________________________________________________________________
________________________________________________________________________
Sign Up for:
Class(s)
__________________________________________________________________
__________________________________________________________________
note that signing up with a family member or taking 2 classes or more you recieve 10% total
with Early Bird 10% is taken after all
discounts
Payment Form:
total :________________
CASH CHECK MASTERCARD VISA
CLI
POLICIES & PARENTAL CONSENTS
1)
I understand all classes are subject to cancellation based on lack of enrollment. (in which
event any monies not used are refunded)
2)
I hereby remove CLI staff and management from any liability for injury or damages incurred
while involved in this program.
3)
I understand that as of the first day of lessons begin all balances must be paid in full
(unless CLI has made other arrangements with student ) and cancellation are non-refundable.
4)
Disruptive Behavior in access, or to the detriment of class will not be tolerated. Repeated
offense may be cause for removal from program without refund.
As
Parent or Guardian of the applicant, I hereby accept all the conditions of enrollment.
Parent/Guardian Initial ________________Date ___________________________________
Photo Release
I
hereby authorize Creative Learning Institute of Dance to use photographs/videos/likeness of
enrolled student(s) for lawful and respectable purposes relating to publicity, choreographic
archives or promotional materials.
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Send e mail to CLIDANCE@SBCGLOBAL.net |