Out On A Limb Dance Company & School

Individual Classes Registration Form September 8, 2008 - May 28, 2009

Please check the classes you are registering for:

	Monday		Tuesday		Wednesday		Thursday		Friday		Saturday
	5:00-6:00 Level 4-6/A Pointe				4:00-5:00 Level 6/A Ballet		4:00-5:30 Level 5/6 A Ballet/Pointe		10:00-11:00 Beginning Dance		10:00-11:00 Beginning Combo
	5:00-6:00 Level 6/A Allegro		5:30-6:30 Beginning Hip Hop		5:00-6:00 Level 5 Ballet		5:30-6:30 Level 2 PAE Rep				11:00-12:00 Fundamentals
	6:30-7:30 Level 2 Ballet		6:30-7:30 Level 1 Tap/Jazz		6:00-7:00 Level 3 PAE Rep		6:30-7:30 Level 3/4 Ballet/Pointe				12:00-1:00 Adv Beginning Combo
	7:30-8:30 Level 3 Ballet		7:30-8:30 Intermediate Hip Hop		7:00-8:00 Level 4 PAE Rep		7:30-8:30 Level 5/6/A Movement				1:30-2:30 Level 5 Jazz
					8:00-8:30 Level 3-6 Men's Class						2:30-3:30 Level 6/A Jazz
	4:00-5:00 Level 6/A Contemporary						4:30-5:30 Fundamentals (ages 3-5)				9:00-10:00 Beg Karate
	6:00-6:30 Level 4/5 Contemporary		5:30-6:30 Level 1 Ballet		5:00-6:00 Level 6/A MT/Tap		5:30-6:30 Level 5/6/A Jazz/Lyrical				10:00-11:00 Intermediate Karate
	6:30-7:30 Level 3/4 Jazz		6:30-7:30 Intermediate Combo		6:00-7:00 Level 4/5 MT/Tap		6:30-7:30 Level 2 MT/Tap		6:30-7:30 Adult Tap		11:00-11:30 Young Men's Class (6-13)
	7:30-8:30 Level 2 Jazz		7:30-8:30 Adult Karate		7:00-8:00 Level 3 MT/Tap		7:30-8:30 Level 3/4 Jazz/Lyrical				11:30-1:00 Level 5 Repertoire
											1:00-2:30 Level 6/A Repertoire

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Hours per	Tuition per	Hours per	Tuition per
Week	Month	Week	Month
1.0	$42.00	8.0	$225.00
1.5	$62.00	8.5	$240.00
2.0	$75.00	9.0	$255.00
2.5	$90.00	9.5	$265.00
3.0	$100.00	10.0	$270.00
3.5	$120.00	10.5	$280.00
4.0	$130.00	11.0	$285.00
4.5	$145.00	11.5	$295.00
5.0	$155.00	12.0	$300.00
5.5	$170.00	12.5	$310.00
6.0	$185.00	13.0	$315.00
6.5	$200.00	13.5	$320.00
7.0	$210.00	14.0	$325.00
7.5	$215.00	14.5	$330.00
		15.0	$350.00

Total Hours per Week Monthly Tuition

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Student information:
Name
Date of Birth Age at Registration Recommended Dance Level
Academic School/Grade School District #

Please give complete mailing address:

Parent/Guardian Name
Street Address
City State Zip Code
Day Ph
Eve Ph
Cell Ph

E-mail addresses will be added to our mailing list and refreshed from this form each session. We will keep you informed this way. Please add your e-mail address to the list even if we already have it. Please print clearly including correct capitalization.

Parent/Guardian E-mail
Student E-mail
Additional emergency contact information:
Emergency Contact Name Relationship
Street Address
Day Ph
Eve Ph
Cell Ph
You may leave any information that you'd like us to give to medical personnel or police if an emergency should arise.(ex. medical conditions, insurance information, etc.)

New students, please tell us how you heard about us:
*Please take good care of your body and use good judgement in class. Out On A Limb Dance Company is not responsible for any injury that occurs during class. If you are experiencing any physical discomfort, please see your physician for a recommendation on whether or not it is safe for you to continue taking class.

Registration fee is $35 per family per year.