Summer 2024

Dancer's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Parent/Guardian's Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home/Cell Phone *

(###)

###

####

Home/Cell Phone #2 *

(###)

###

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Emergency Contact Phone *

(###)

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Please check the classes you would like to enroll in *

Monday 4:00 to 4:30p Creative Movement - Magen

Monday 4:30 to 5:15p 3-4yrs Ballet & Tap - Magen

Monday 4:30 to 5:15p Acro: Preschool Division - Sam

Monday 5:15 to 6:00p Team: Strength/Conditioning - Sam

Monday 5:30 to 6:30p Acro: Pre-JR Division - Sarina

Monday 6:00 to 7:00p Team Ballet -Sam

Monday 6:30 to 7:30p 8+yrs Hip Hop - Sarina

Monday 7:00 to 8:00p Pre-Pointe/Pointe Technique - Sam

Monday 7:30 to 8:30p Acro: JR Division - Sarina

Monday 8:00 to 9:00p Adult Tap - Sam

Tuesday 4:00 to 5:00p 5-7yrs Hip Hop & Tumble - Magen

Tuesday 4:30 to 5:30p Team: Production - Olivia

Tuesday 5:00 to 6:00p Team V - Magen

Tuesday 5:30 to 6:30p Team I - Olivia (at least one technique class required)

Tuesday 6:00 to 7:00p 8+yrs Ballet - Magen

Tuesday 6:30 to 7:30p Team III - Olivia (at least one technique class required)

Tuesday 7:00 to 8:00p Acro: JR Division - Magen

Tuesday 7:30 to 8:30p Team II - Olivia (at least one technique class required)

Wednesday 3:30 to 4:00p Creative Movement - Megan

Wednesday 4:00 to 5:00p Acro: JR II Division - Amanda

Wednesday 4:00 to 4:45p 3-4yrs Ballet & Tap - Megan

Wednesday 4:45 to 5:45p 5-7yrs Ballet & Tap- Megan

Wednesday 5:00 to 6:15p Competitive Acro Team Workshop Amanda

Wednesday 5:45 to 6:45p 8+yrs Jazz/Lyrical - Megan

Wednesday 6:15 to 7:00p Team: Turns - Amanda

**4 SPOTS LEFT** Wednesday 7:00 to 7:45p Team: Leaps & Jumps- Amanda

Thursday 4:00 to 4:30p Creative Movement - Magen

Thursday 4:30 to 5:15p 3-4yrs Ballet & Tap - Magen

3 Week Workshop: 8/1, 8/8, 8/15 5:00 to 7:00p 10+ yrs Jazz/Lyrical Workshop - Sam

7/15 to 7/19 Tutus & Tiaras 10:00a-12:00p 3-4yrs Madison

**FULL, WAITLIST** 7/15 to 7/19 Let's Get Fancy 9:00a-12:00p 5-8yrs Magen

8/5 to 8/9 Oh La La Aloha 10:00a-12:00p 3-4yrs Magen

8/5 to 8/9 Oh La La Aloha 9:00a-12:00p 5-8yrs Megan

8/12 to 8/16 Beach Party 10:00a-12:00p 3-4yrs Dylann

8/12 to 8/16 Into the Wild! 9:00a-12:00p 5-8yrs Magen

Tuition & Late Fees *

- Tuition will be billed at the end of June. - There is a $35 non-refundable registration fee. - There is a $25 service fee for a returned payment. - There is a $25 late fee for past due tuition -If the tuition is not paid by the due date, your dancer will be withdrawn from the class or camp that was selected.

I've read the above and agree

Withdrawal *

-Class withdrawal requires a 30-day written notification or you are responsible for full tuition.

I've read the above and agree

Photo Release (Please select ONE) *

I hereby grant and authorize Melrose Dance Academy the right to take, edit, alter, copy and make use of any and all pictures or videos taken of my dancer to be used in and/or for promotional materials including, but not limited to, newsletters, flyers, posters, brochures, letters, annual reports, and social networking sites for business use only. This is done without payment or any other consideration. This authorization shall continue indefinitely unless parent/guardian revoke in writing. I understand and agree that these materials shall become the property of Melrose Dance Academy and/or other facility that I represent, and will not be returned.

I DO NOT consent to the above Photo Release agreement and I do not want my dancer’s picture used for promotional materials, including, but not limited to, newsletters, flyers, posters, brochures, letters, annual reports, and social networking sites for business use only. Any photographs or digital images in which the subjects cannot be identified by the naked eye (i.e. wide shots of the stage containing the entire cast of the Recital) will be published at the discretion of Melrose Dance Academy.

-Please be advised that all dancers dance at their own risk at Melrose Dance Academy. I understand and agree to hold harmless, all instructors, assistants, aides, managers, and all affiliates to Melrose Dance Academy for any and all injuries that may result from my child/me participating MDA’s dance program. Additionally, I agree that Melrose Dance Academy is not responsible for any lost or stolen items that may occur while participating. *

I've read the above and agree

Medical Release *

In the event you are unable to reach me, in the case of accident or injury, I give my permission for treatment as deemed necessary by Melrose Dance Academy staff or emergency personnel. I also release Melrose Dance Academy and staff of liability in case of injury or accident.

I've read the above and agree

COVID-19 *

I agree to follow and have my dancer(s) follow all Melrose Dance Academy protocols and understand that failure in doing so will result in not being able to return to class. I agree to only send my dancer(s) if they have not in the past 10 days: experienced any symptoms such as coughing, fever, shortness of breath, sore throat, etc. or been exposed to anyone who may have been in contact with the virus

I've read the above and agree

Date *

MM

DD

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