Summer 2011 Masters Club Registration Form

Student Name: ________________________________________________________________________

Age:_____________ Current Grade:______________Current Team or Core:_______________________

Phone:_______________________________________________________________________________

Enrolling in the following classes:

ALL
Tuesday, August 2: Contemporary Hip Hop with Jennifer Weber & Ballet with Brian Roberts
Thursday, August 4: Lyrical with Theresa Stone & Ballet with Brian Roberts
Tuesday, August 9: Contemporary with Tony Jackson & Ballet with Jill Silverman
Thursday, August 11: Musical Theatre/Jazz with Corey Wright & Ballet with Jill Silverman
Tuesday, August 16: Contemporary/Modern with Jennifer Jones & Brian Roberts
Thursday, August 18: Hip Hop with Brian Henninger & Ballet with Brian Roberts
Tuesday, August 23: Breaking & Hip Hop with Casie Goshow & Ballet with Brian Roberts
Thursday, August 25: Jazz with Kevin Guy & Ballet with Brian Roberts

Individual classes are $70 per day. If you register for 4 or more classes, the cost is $60 per day.

Total Classes: ______________________________ Total Cost:______________________________

*Registration Deadline: June 15th

I, the undersigned Parent or Guardian of the above student, release BROADWAY BOUND DANCE CENTER, including instructors and assistants, from any and all injuries which may occur from training, practicing, performing and/or during any event or activity. I also agree that I am responsible for the health and accident insurance and any medical costs for the above student incurred due to injury including, but not limited to, emergency medical transportation and treatment if the need arises. I understand that BBDC has a NO REFUND policy. If a student drops, the account will be credited the remaining balance and will be saved for up to one year. I also give my permission for the public display of any studio pictures that my child may be in.

Name:_______________________________Signature:________________________Date:___________