Registration Form Please enable JavaScript in your browser to complete this form.Name of Dancer *Address for Receiving Mail *Email *Parent(s) Name *Home Phone Work PhoneCell Phone *School Attending in Fall: *Grade dancer will be in the Fall *Date of Birth *Age *List daycare or after school program for your childList Prior Dance history, if any: Please make note of any physical, medical limitations or medications of dancer: *Class Registration: Check the type of classes that you are registering for: *Tiny Tots - Preschool combination class for 2 & 3 years old that will include Ballet & Creative MovementPreschool Combination Class (4 year olds & 5 year olds) that will include Ballet, Tap & Creative MovementSchool Age Combination Classes to include Ballet, Tap & Jazz (Suggested for 1st grade - 6th gradeAcrobatic/Tumbling (Preschool & Up)Ballet (Suggested for the serious dancer, 7th grade & up (2) days a week, if Ballet, Tap and Jazz are selected)Tap (Suggested for the serious dance 7th grade up)Jazz (Suggested for the serious dancer 7th grade up)Troope Class (to be eligible for troope, one must take all three classes in Ballet, Tap & Jazz for at least a period of 1 year and be 4th grade in school). Must meet the approval of teacher by interview and review for all new and returning dancers.Intensive Class designed for the very serious dancer. Dance competitions are a requirement of this class. Competition fees are NOT included in tuition. Must take Ballet, Tap, Jazz & be a member of the All That Glitters Dance Troope and must attend summer Boot Camp. *By teacher(s) recommendation only.Hip-Hop for school-aged Beginners through Advanced StudentsPointe (Teacher recommendation only)Mommie and Me Class (designed for the toddler and caregiver to share Music & Movement together). Fall and Spring sessions - no registration form required.Additional Info: How did you hear about us?IN CASE OF EMERGENCY: Name of Contact *IN CASE OF EMERGENCY: Relationship to Student *IN CASE OF EMERGENCY: Home Phone *IN CASE OF EMERGENCY: Cell Phone *Read & Sign *Parent/Guardian E-Signature (check box to sign)I will pay MWSOD a $40 registration fee by check, cash or card before my dancers first class. I hereby give permission for images of my child, captured during regular dance classes, rehearsals, performances and special activities through video, photo and digital camera, to be used solely for the purposes Mallory Ward School of Dance, LLC DBA Carolyn Ellis School of Dance promotional materials, newsletters, websites and publications, and waive any rights of compensation or ownership thereto. If you do not agree with the above statement, it is your responsibility to submit a written letter to Mallory Ward School of Dance, LLC DBA Carolyn Ellis School of Dance stating your disagreement. By the e-signature above, I agree that the information provided is true. I hereby agree to abide by the rules and regulations of Mallory Ward School of Dance, LLC DBA Carolyn Ellis School of Dance, a copy of which will be provided to me upon final registration. I agree that Mallory Ward School of Dance, LLC DBA Carolyn Ellis School of Dance, and its employees are not liable for any injuries or damages including, without limitation, direct, incidental, special, consequential or punitive damages in connection with or arising from the students enrollment or use of the Mallory Ward School of Dance, LLC DBA Carolyn Ellis School of Dance, and facilitiesSubmit
