2023 Dance Academy at St. Catherine's

Sign up below for classes. You may select multiple classes for one or more children within your family. There is a $10 registration fee with this submission. Individual invoices will be sent out next week prorated for August. Dance classes are priced per month as follows:

1 class per week: $55

2 classes per week: $105

3 classes per week: $135

4 classes per week: $160

5 classes per week: $175

Family Information
Parent Name

First NameLast Name
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Street Address

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Parent Phone Number*
Parent Email Address*

Confirmation EmailEmail Address
Primary Language Spoken at Home*
Please Click on the Medical Release Information box below to continue.

Medical Release Information
Medical/Hospital Insurance Carrier*
If you do not currently have Medical Insurance, type "None" in the box.
Name of Policy Holder
Policy Number
Group Number
Emergency Medical Treatment Release: In the event of an emergency, by initialing below, I hereby give permission to transport my child(ren) to a hospital for emergency medical attention and grant permission for non-prescription medications to be given, if deemed appropriate. (Any prescription medication to be given must be accompanied by a physician’s prescription or a parent note which should be provided separately). I wish to be advised prior to any further treatment by the doctor and hospital. If you are unable to reach me, my spouse, or the other desginated guardian, contact the Backup Emergency Contact below.
Medical Release Approval (Please initial below to approve above medical release)*
Emergency Contact*
Phone Number*
Please Click on the Child #1 Information box below to continue.

COVID Release/Payment Information/Authorization
ASSUMPTION OF THE RISK RELATING TO COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person to person through respiratory droplets when an infected individual coughs, sneezes or speaks. As a result, government agencies at all levels and federal, state and local health agencies recommend social distancing and have placed limits on the congregation of groups of individuals.

St. Catherine of Siena Parish has put preventative measures in place to reduce the spread of COVID-19; however, the parish cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending activities on the campus of St. Catherine of Siena Parish could increase your risk and that of your children for contracting COVID-19.

While St. Catherine of Siena Parish will make all reasonable efforts to lower the risk of COVID-19 exposure and spread at the parish, the parish is unable to provide any guarantee that students or their families will not be exposed to or infected by COVID-19.

By enrolling your child(ren) in and attending parish faith formation, you acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that you, your child(ren) and or other family members may be exposed to or infected by COVID-19. It is expected that students and other family members will follow the preventative measures and guidelines implemented by St. Catherine of Siena Parish including not coming to the parish premises if demonstrating any signs or symptoms of COVID-19.

Registration$10.00

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By signing below, I authorize payment if applicable and confirm the medical, media, and social media release information. I also confirm that I have read and accepted the COVID-19 release. Please note that you will not be able to submit this form until you have signed.
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