THEATRE WINTER HAVEN S COMMUNITY DANCE CENTRE

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1 THEATRE WINTER HAVEN S COMMUNITY DANCE CENTRE Ages 3-4 Pre-Ballet/Tap Combo Ages 5-6 Ballet/Tap Combo Ages 7-18 Ballet Tap Jazz Modern Musical Theatre Adults Jazz Tap Classes Begin August 27th! Classes will run through May 17, Free Class Placement Workshops June 9th & August 18th Theatre Winter Haven - North Entrance (Upstairs) Ballet: Jazz: Modern: Musical Theatre: Tap: 10:00AM - 10:50AM 11:00AM - 11:50AM 12:00PM - 12:50PM 1:00PM - 1:50PM 2:00PM - 2:50PM Dress comfortable to dance for the placement workshops. A specific dress code for classes will be given upon registration. Theatre Winter Haven Chain of Lakes Complex 210 Cypress Gardens Blvd, Winter Haven, FL (ph) ext. 105

2 Class Schedule Day Time Studio 1 Studio 2 4:00PM - 4:45PM Tap III 5:00PM - 5:45PM Musical Theatre II/III Musical Theatre I Monday 6:00PM - 6:45PM Adult Tap 55+ Tap I 7:00PM - 7:45PM Tap II Adult Jazz 4:00PM - 4:45PM Ballet/Tap Combo (5-6) Modern I 5:00PM - 5:45PM Jazz I Modern II Tuesday 6:00PM - 6:45PM Ballet I Modern III 7:00PM - 7:45PM Ballet III Jazz II Ballet II Jazz III 4:00PM - 4:45PM Tap III 5:00PM - 5:45PM Musical Theatre II/III Musical Theatre I Wednesday 6:00PM - 6:45PM Adult Tap Tap I 7:00PM - 7:45PM Tap II 4:00PM - 4:45PM Ballet/Tap Combo (5-6) Modern I 5:00PM - 5:45PM Jazz I Modern II Thursday 6:00PM - 6:45PM Ballet I Modern III 7:00PM - 7:45PM Ballet III Jazz II Ballet II Jazz III Friday 4:00PM - 4:45PM 5:00PM - 5:45PM 6:00PM - 6:45PM 7:00PM - 7:45PM Saturday 10:00AM - 10:30AM Ballet/Tap Combo (3-4) Classes will not meet: November 19-24, 2018 December 22, 2018-January 4, 2019 March 25-30, 2019

3 Registration Form 1 - Dancer Information Dancer s Name Date of Birth Phone Number 2 - Parent/Guardian Information Address Address City/State/Zip Phone Number Emergency Contacts Phone Number Phone Number Phone Number Medical Information Any special medical conditions or concerns? Allergies? (If yes, please list) Any prior injuries? (If yes, please list) Please note that if teachers know about medical conditions or prior injuries, it can help them adjust for that student who may have struggle with different techniques and restraints.

4 Class Selection & Pricing 5 - Class Selection Dancers Classes Pre-Ballet/Tap Combo (3-4) Ballet/Tap Combo (5-6) Ballet (I, II or III) Jazz (I, II or III) Modern (I, II or III) Musical Theatre (I, II or III) Tap (I, II or III) Adult Jazz Adult Tap Adult Tap 55+ Total Classes per Dancer Monthly Class Rates (Per Student) Students (Ages 5-18) Classes meet twice weekly. 1st nd rd Dancer 1 Class $60 $55 $50 2 Classes $95 $90 $85 3 Classes $125 $120 $115 4 Classes $140 $135 $130 5 Classes $150 $145 $140 Tiny Tots (Ages 3-4) & Adults Classes meet once weekly. 1st nd rd Dancer 1 Class $35 $30 $25 2 Classes $60 $55 $50 Levels will be determined by the instructor based on placement classes. Please note that the difference in prices is because student classes meet twice weekly, while Tiny Tots and Adults meet only once weekly. 6 - Monthly Payments Number of Classes Monthly Total Monthly Rate Registration Fee $ Payment Information O Credit Card O Check O Cash O Monthly O In-Full (1 payment) O Semesters (2 payments) Credit Card Information Name on Card Card Number Exp. Date CVC Zip Code Credit card payments will be processed on the 1st of each month from September - May. If you chose to pay in full for the year (9 months) you will receive a 10% discount on all class fees. If you chose to pay by semester (4 months in September/5 months in January) you will receive a 5% discount on all class fees.

5 Waiver & Release Dancer Name: Date of Birth: / / Liability and Release Waiver Dancing is a strenuous activity from which injuries could arise. Theatre Winter Haven, Inc (TWH), the instructors and employees are not liable for personal injuries, or loss of, or damage to personal property. Each student may decline to participate in any activity. Please inform TWH and instructor of any physical limitations you may have. If you are in doubt as to your physical abilities, please consult your physician before participating. I represent that I am, or my child is, physically able to participate in all activities. I hereby authorize any and all medical attention to be administered to myself or child, in the event of accident, injury, sickness, etc., under the direction of TWH, until such time as I or the appointed emergency contact person may be contacted. I assume the responsibility for the payment of any such treatment. I have notified TWH of any special medical needs or information required for myself or child. I, for myself, my child, my spouse, heirs, legal representatives and assigns, expressly release, waive, discharge and hold harmless TWH, its officers, directors, employees, instructors, agents, successors, predecessors, sponsors, legal representatives and assigns from all claims, demands, losses, actions, judgments, suits, executions and liabilities of any kind. In addition, this release is for the entire premises of the Chain O Lakes Complex, including but not limited to common areas, restrooms, changing rooms, rehearsal/dance areas, offices, sidewalks, stairwells, elevators, parking areas and grounds and any location an activity may be held. Photography and Video Release By my child s participation in Theatre Winter Haven programs, I consent to the reproduction and/or use of any and all photographs, videotapes, films, or other recordings of my child for advertising, promotional or other purpose by Theatre Winter Haven (without compensation to my child or me). Printed Name: Signature: Date: O I accept the Liability and Release Waiver O I accept the Photography and Video Release If dancer is under the age of 18, parent or guardian signature is required.

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