MISS LORES SCHOOL OF PERFORMING ARTS SUMMER 2016
PO BOX 16 ESSEXVILLE, MI 48732 684-1659 OR 89D-ANCE
PLEASE TYPE/PRINT NAME______
AGE (9/14) _____DATE OF BIRTH______GRADE (9/14) ______HOME PHONE ______
ADDRESS______CITY______ZIP______
MOTHER’S NAME______FATHER’S NAME______
EMPLOYMENT______EMPLOYMENT______
CELL PHONE#______CELL PHONE#______
EMAIL ADDRESS:______EMAIL ADDRESS:______
EMERGENCY NAME & NUMBER______
CLASSES DESIRED: PLEASE CIRCLE Classes Desired. PRESCHOOL DANCE & TUMBLING
TAP ACRO/GYM JAZZ LYRICAL/CONTEMPORARY BALLET TURNS/LEAPS
Summer Registration Fee: $10.00. It is non-refundable and due at the time of registration.
“I hereby assume all financial responsibility for the above student enrolled at Miss Lore’s School of Performing Arts. I further understand that I will be held responsible for all expenses, until I notify the office and teachers that the above student will no longer be attending class.”
Miss Lore’s School of Performing Arts does no carry medical insurance for the students. It is required that all our students be covered by their own family insurance policies and if injury occurs it is understood that the student’s own policy is your only source of reimbursement.
PARENTS/GUARDIAN, PLEASE SIGN: ______DATE:______
To be filled out by studio staff: Date Rec’d ______R-fee ______
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MISS LORES SCHOOL OF PERFORMING ARTS SUMMER 2016
PO BOX 16 ESSEXVILLE, MI 48732 684-1659 OR 89D-ANCE
PLEASE TYPE/PRINT NAME______
AGE (9/14) _____DATE OF BIRTH______GRADE (9/14) ______HOME PHONE ______
ADDRESS______CITY______ZIP______
MOTHER’S NAME______FATHER’S NAME______
EMPLOYMENT______EMPLOYMENT______
CELL PHONE#______CELL PHONE#______
EMAIL ADDRESS:______EMAIL ADDRESS:______
EMERGENCY NAME & NUMBER______
CLASSES DESIRED: PLEASE CIRCLE Classes Desired. PRESCHOOL DANCE & TUMBLING
TAP ACRO/GYM JAZZ LYRICAL/CONTEMPORARY BALLET TURNS/LEAPS
Summer Registration Fee: $10.00. It is non-refundable and due at the time of registration.
“I hereby assume all financial responsibility for the above student enrolled at Miss Lore’s School of Performing Arts. I further understand that I will be held responsible for all expenses, until I notify the office and teachers that the above student will no longer be attending class.”
Miss Lore’s School of Performing Arts does no carry medical insurance for the students. It is required that all our students be covered by their own family insurance policies and if injury occurs it is understood that the student’s own policy is your only source of reimbursement.
PARENTS/GUARDIAN, PLEASE SIGN: ______DATE:______
To be filled out by studio staff: Date Rec’d ______R-fee ______
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