WELCOME TO REGISTRATION FOR

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1 WELCOME TO REGISTRATION FOR NO ONLINE registration this year!!!! REGISTRATIONS MUST BE MAILED IN & MUST INCLUDE THE FOLLOWING. 1. Completed registration form 2. $ deposit 3. Liability Waiver 4. Picture of your child ** REGISTRATION WILL NOT BE ACCEPTED IF IT DOES NOT INCLUDE ALL OF THE ABOVE Scroll down for all the necessary registration papers. New students should Jane - jlopoten@gmail.com to help select the proper class or classes. Thank you and have a wonderful day!!!!

2 Please Note... All classes start the week of September 11 th NEW STUDENTS OPEN HOUSE SCHEDULE Tuesday, September 5th...11:00am - 7:00pm Wednesday, September 6th...11:00am - 7:00pm Saturday, September 9th...11:00am - 2:00pm Please call me with any questions or concerns at REGISTER NOW For Dance Season All classes start the week of September 11th CLASSES CAN ONLY BE HELD WITH A COMPLETED REGISTRATION FORM, DEPOSIT, LIABILITY FORM AND PICTURE OF YOUR CHILD. This deposit is applied to the first tuition payment. There is no registration fee. Refunds are not given after the 4th class.

3 REGISTRATION FORM A picture of your child along with the signed liability form is required with your registration or it will not be accepted. Please send in the form below with a $100 NON-REFUNDABLE DEPOSIT. This deposit will be applied toward the first payment. The balance is due at the first lesson, or may be paid at any of our OPEN HOUSES. TUITION: PLEASE SEE ENCLOSED INFORMATION. You will receive a confirmation and the balance owed when your registration is received. Refunds will be given for any class that is cancelled due to registration. Student s Name: Class Type/Day/Time Student s Class Type/Day/Time Student s Cell #: Class Type/Day/Time Mother s Name: Class Type/Day/Time Mother s Class Type/Day/Time Mother s Cell #: Class Type/Day/Time Father s Name: Class Type/Day/Time Father s Class Type/Day/Time Father s Cell: Class Type/Day/Time Age as of September 2017 Birthdate Amount Enclosed $ School/Grade in Fall Please make checks payable to: Jane Lopoten School of Dance Years of dance experience and in which forms of dance LIST MEDICAL CONDITIONS & ALLERGIES ON REVERSE SIDE.

4 TUITION ROMAN NUMERAL CLASSES 1 Class 4 payments of $ Classes 4 payments of $ Classes 4 payments of $ Classes 4 payments of $ Classes 4 payments of $ Classes 4 payments of $ Once a student has completed his/her first year of hour jazz and hour ballet classes, then they will receive lyrical class for free the following year. These prices refer only to students taking ALL Roman Numeral Classes. Our payment schedule has been designed to encourage our dancers to take more than one class per week, in more than one form of dance. **Please be reminded that each class will have his/her own costumes for the recital. A $50.00 DEPOSIT IS REQUIRED FOR EACH COSTUME. No Registration Fees CREATIVE DANCE TO LEVEL 5 1 Child or 1 Class 4 payments of $ nd Child or 2nd Class 4 payments of $ rd Child or 3rd Class 4 payments of $ th Class 4 payments of $ /2 Hour class taken with Combination Class add...4 payments of $70.00 PAYMENT SCHEDULE (for all classes) 1st Payment due at 1st lesson (less $ non-refundable deposit) 2nd Payment & Costume Deposit due week of...october 30th 3rd Payment & Recital Fee due week of...january 8th 4th Payment & Costume Balance due week of...march 12th NO REFUNDS GIVEN AFTER THE FOURTH CLASS. All accounts must be paid in full for students to perform in the Recital.

5 STUDIO 1 Megan INTRO MODERN DANCE SCHEDULE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY Jane Jane Kristine Jane Kara 5:00-6:00 4:00-5:00 Kristine Kristine Kara Johanna MODERN MODERN 6:30-7:00 7:00-8:00 8:00-9:00 7:30-8:00 8:00-9:00 6:00-7:00 7:00-7:30 NEW! 7:00-8:00 INTRO PRE-POINTE Kristine 9:00-9:30 9:00-9:30 JAZZ 3:00-4:00 4:00-5:00 STUDIO 2 Class for children with Down Syndrome MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY Jen Jen Jen Carol Jen Jen 4:30-5:45 4:30-5:45 JAZZ 5:00-6:00 (4 Jane/Jen 6:00-7:00 NEW! NEW! Jen INTRO 7:00-7:30 TAP NEW! Jane TAP See Brochure JAZZ Jane & Jen TAP you must register for the class that has been highlighted NOTE: Each combination of classes (i.e. JAZZ/BALLET, TAP/BALLET, JAZZ/TAP) has it s own leveling system for the purpose of our teaching staff. If you child changes to a different type of combination class from last year the level may not be sequential. SEE REVERSE SIDE FOR MORE INFORMATION

6 VACATION, HOLIDAY SCHEDULE & IMPORTANT DATES Classes Start: All classes start the week of September 11th. Halloween: No classes on Tuesday, October 31st. Thanksgiving: No classes Wednesday, Nov. 22nd thru Saturday, Nov. 25th. Classes will resume on Monday, November 27th, Holiday Break: No classes Friday, Dec. 22nd thru Monday, January 1st, Classes resume on Tuesday, January 2nd, Spring Break: No classes Monday, March 26th through Saturday, March 31st, Classes resume on Monday, April 2nd, October 29th Dance-a-thon to raise money for Susan G. Komen 12 pm to 4 pm. JANE LOPOTEN SCHOOL OF DANCE

7 RECITAL INFORMATION Creative Dance Program: A recital is given at the studio. A $ fee will cover the cost of the costume and the recital. Saturday classes, recital will be Sunday, May 6th. Costume Deposit: Creative Dance to Level 5 A $50.00 nonrefundable costume deposit is due with the 2nd payment. Costumes will not be ordered without this deposit. All Roman Numeral Classes A $50.00 deposit is required for each class your child is enrolled in. All deposits are non-refundable. Combination Classes Levels 2, 3, 4 & 5 that include Jazz will owe a $50.00 deposit for tap/ballet and a $50.00 deposit for Jazz. Recital Information: Dress rehearsals are May 22nd, 23rd and 30th. Students will be informed in December of the date and time of their rehearsals and recitals. The 2018 Recitals will be Saturday, June 2nd and Sunday, June 3rd. Recital Fee will be billed with the 3rd payment: 1st Child - $115.00* 2nd Child - $40.00* This fee entitles your family to unlimited seating. (does not apply to Creative Dance program) * All accounts must JANE LOPOTEN be paid in full SCHOOL OF DANCE for students to perform in the Recital.

8 JANE LOPOTEN SCHOOL OF DANCE INC. Liability Waiver Form I understand and agree that in participating in dance classes and/or other dance-related activities there is the possibility of physical injury. I (the dancer and/or parent/guardian) voluntarily agree to assume the full risk and responsibility of injury, damage or loss that I or my minor child may sustain as a result of participating in dance classes or other dance-related activities conducted by or at Jane Lopoten School of Dance. I agree to release, indemnify and hold harmless Jane Lopoten School of Dance Inc., its owners, employees, teachers, dancers, staff members, volunteers, assistants, independent contractors and representatives from any and all liability, claims, demands, causes of action, damages, loss or injury to me and/or my minor child or property which result from or arise out of, directly or indirectly, participation in dance classes or dance-related activities conducted by or at Jane Lopoten School of Dance. I understand I should be aware of my physical limitations and I agree not to exceed them. I HAVE READ AND FULLY UNDERSTAND THE ABOVE WAIVER AND RELEASE OF ALL CLAIMS. If I am signing this waiver on behalf of my minor child, I certify that I am the parent or legal guardian and have the right to waive these rights. Dancer s Name (Print): Dancer s Signature: Age: Date: Parent/Guardian Name (Print): Parent/Guardian Signature: Phone: Date: