EUREKA DANCE PROGRAM
***********NEW AND OLD PARTICIPANTS - PLEASE READ CAREFULLY*************
The dance program is sponsored by the Eureka County Juvenile Probation Department. The one-time registration fee and a portion of the monthly class fees are used to pay Clog.org for music copyright fees and membership dues. The balance of the monthly class fees are paid to the individual instructors.
All fees must be paid by the due date posted on each bill. We are willing to work around pay dates, but all fees (registration, class, and costume) must be paid in a timely manner. If you need to set up a payment schedule, please contact the Juvenile Probation Department to make arrangements. Dance bills may be pro-rated at the end of the dance year to reflect cancelled practices.
All fees must be paid prior to or within two weeks after the dance recital.
Students are expected to arrive on time and be prepared to dance. Classes are limited to 45 minutes, so time is precious. There are only 14 practices before recital, and the dancers are expected to learn two dances. Please be aware of your child's class schedule, especially the start and end times. If a class is cancelled, the instructor will schedule either a make-up class or post a credit to your bill at the end of the dance year. You will be billed if your child does not show up for class. It is your responsibility to advise Irma/ Steve or instructor of child not attending class.
If your child misses 2 or more practices in a month, they may be removed from the class.
Our instructors and the Eureka Elementary school are not responsible for your child after dance class has ended. Please make sure you have arranged to pick up your child after class. No child may be left at the school after dance practice
UNLESS
they are attending the after-school program and it is still in session.
Parents may observe the classes at the instructor's discretion. If you are asked to wait outside, please do not be offended. This is in the best interest of the individual class and all of the participants.
Classes are standard dance classes. If an individual class becomes a competition group, it will be at the discretion of the class instructor and the Eureka Juvenile Probation Department.
Costumes are purchased for all classes. You are responsible to pay the fee for your child's costume(s). Every effort is made to keep costs down, however you do need to be aware that if your child is in more than one class or you have more than one child, this could become an expensive venture.
These fees must all be paid prior to or within two weeks after the dance recital.
2026 Juvenile Probation Dance Registration Form
Student Name:
Age:
Grade:
Ballet (street shoe size):
Clog (street shoe size):
Class interest: (Please mark the classes your child is interested in.)
Ballet
Clog
Hip Hop
Tumbling (2.5-5)
Photo Release: The above named student may have their photo printed in publications and news articles for Juvenile Probation. It is understood that there will be no monetary compensation for use of these photos. Photos may be used in media, educational and advertising materials.
Best form of contact: (to send out dance schedules and any information about dance)
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Dance schedules will also be available online at https://www.eurekacountynv.gov/departments/juvenile-probation/programs/dance-program/
Registration fee: $10.00/child:
Monthly class fees: $15.50/class or $10.50/class (3 or more classes per family):
Shoes: If you did not find shoes at registration, please fill in shoe size and we can order them at reasonable prices.
PARENTAL MEDICAL/CONSENT FORM
Program: Dance Program
**Please observe drop off and pick up times
Name:
First Name
Middle Initial
Last Name
Age:
Gender: M or F
F
M
Date of Birth:
-
Month
-
Day
Year
Date
Parent Guardian Name:
First Name
Last Name
Parent/Guardian Phone:
-
Area Code
Phone Number
Parent Guardian Name:
First Name
Last Name
Parent/Guardian:
-
Area Code
Phone Number
Mailing Address:
Email address:
example@example.com
Alternate email address (if applicable):
example@example.com
MEDICAL INFORMATION
Name of person to contact in case of emergency: (secondary to parent/guardian).
Phone number of person to contact in case of emergency: (secondary to parent/guardian)
Format: (000) 000-0000.
List all special health concerns:
Medication taken:
List all medications that should not be administered:
List all known allergies:
Activity restrictions:
As legal guardian of the named participant, knowing the risks involved, I give my permission for him/her to participate in all activities for said program. In addition, I authorize all instructors, directors, coaches, and assistants to obtain medical care for my son/daughter in the event that such is needed. Further permission is hereby granted to the licensed physician or accredited hospital and their associates to perform any medical and/or surgical procedures deemed essential to the treatment of the above named participant. I further agree to be responsible for payment of such care.
Signature of Parent or Legal Guardian
Date
-
Month
-
Day
Year
Date
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