ANNEMARIE'S DANCE ACADEMY
ONLINE REGISTRATION FORM 2009-2010

Click here to see 2009-2010 schedule
 
There is a non-refundable $25.00 Registration Fee ($40 max/family) -- Please make cheque payable to "Annemarie's Dance Academy".
Mail or drop off to 70 Centennial Rd, Unit 1B, Orangeville, L9W 1P9. Your placement in class(es) will be confirmed after your cheque is received.
Please note that there is no registration fee for Term Classes and Preschool Combo Class but class fee must be paid in full to be placed in the class.
The Preschool Combo Class: Tue is $85. The Term Adult classes are $80 each. Both run for 8 weeks.
If we need additional information we will call or e-mail you.

*** IMPORTANT: PLEASE fill in ALL applicable fields, even if you are registering a returning student! ***

Are you registering a returning student? YES   NO
FAMILY NAME (of child/children):  
Billing Name: [First] [Last, if different]  
Street Address:  
Town:      Postal Code:  
Home Phone #:
[Use format 999-999-9999]		  
E-Mail Address:
Parent Information: Phone#'s:
Mother:
 Day:
 Eve:
 Cellular:
 Pager:
      
Father:
 Day:
 Eve:
 Cellular:
 Pager:
Emergency contact:
[In case parents cannot be reached]
Emerg Contact Phone#:
Emerg Contact Relationship:

Annemarie's Dance Academy is not responsible for injuries occurred outside the dance class.
STUDENT #1:
First Name Last Name Female   Male
Date of birth: YY MM DD Health Card Number  
Please check off classes student is registering in:
       Kinder Rhythm [Age 3]     Jazz      Tap      Ballet      Acro      Hip Hop      Lyrical
Preschool Combo Class:      4-5 yr Jazz/Tap Combo Class:      4-5 yr Mini Hip-Hop Class:      Triple S Class:     
Term Adult Class: Ballet Hip Hop Tap
STUDENT #2:
First Name Last Name Female   Male
Date of birth: YY MM DD Health Card Number
Please check off classes student is registering in:
       Kinder Rhythm [Age 3]     Jazz      Tap      Ballet      Acro      Hip Hop      Lyrical
Preschool Combo Class:      4-5 yr Jazz/Tap Combo Class:      4-5 yr Mini Hip-Hop Class:      Triple S Class:     
Term Adult Class: Ballet Hip Hop Tap
STUDENT #3:
First Name Last Name Female   Male
Date of birth: YY MM DD Health Card Number
Please check off classes student is registering in:
       Kinder Rhythm [Age 3]     Jazz      Tap      Ballet      Acro      Hip Hop      Lyrical
Preschool Combo Class:      4-5 yr Jazz/Tap Combo Class:      4-5 yr Mini Hip-Hop Class:      Triple S Class:     
Term Adult Class: Ballet Hip Hop Tap
STUDENT #4:
First Name Last Name Female   Male
Date of birth: YY MM DD Health Card Number
Please check off classes student is registering in:
       Kinder Rhythm [Age 3]     Jazz      Tap      Ballet      Acro      Hip Hop      Lyrical
Preschool Combo Class:      4-5 yr Jazz/Tap Combo Class:      4-5 yr Mini Hip-Hop Class:      Triple S Class:     
Term Adult Class: Ballet Hip Hop Tap
How did you hear about us?
Current Student
Word of Mouth
Website Search
Newspaper
Flyer/Brochure
Advertisement (please specify)    
Other (please specify)    

Additional information:


THANK YOU!
Someone from Annemarie's Dance Academy will get back to you shortly.


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