Out On A Limb Dance Company

Dance for Life Program *NEW*

Performing Arts Ensemble

Classes & Training

Stage Acrobatics

Bronze: Thursdays 7:30-8:30
Silver/Gold: Thursdays 7:30-900
Tuition for stage acrobatics is $30 per month.

Stage Acrobatics Registration Form 2010-2011

Bronze: Thursdays 7:30-8:30
Silver/Gold: Thursdays 7:30-900
Tuition for stage acrobatics is $30 per month.

"A 10% tuition discount will be given to students who are in or have a family member in the dance program."

Student Name
New Student? Yes No	Date of Birth
Age at Registration	Start Date
Please give complete mailing address:
Parent/Guardian Name(s)
Street Address	City
State	Zip
Day Phone	Eve Phone	Cell Phone
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 email address to the list even if we already have it on file.
Parent/Guardian E-mail Address
Student E-mail Address
Additional emergency contact information:
Name/Relationship
Eve Phone	Cell Phone
You may leave any information here that you’d like us to give to medical personnel or police if an emergency should arise (ex. medical conditions, etc.)

* Please take good care of your body and use good judgment 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 year per family.

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Out On A Limb Dance Company
1535 W. Larpenteur ave.
Falcon Heights, MN 55113
651-644-3802