Out On A Limb Dance Company & School
Performing Arts Ensemble Registration Form
September 10, 2007 - May 30, 2008

Please check the level you are registering for:

Apprentice & Level 6: 9.5 hours/week $265/month

Level 5: 8.5 hours/week $240/month

Level 4: 6.5 hours/week $200/month

Level 3: 6 hours/week $185/month

Level 2: 4 hours/week $130/month

Also available for PAE students:
Thursday 7:30-8:30 Movement
Wednesday 8:00-8:30 Level 3-6 Men's Class
Wednesday 8:00-8:30 Young Men's Class (ages 6-13)

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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.