2020-21 ADC Trial Class Registration

2020-21 Trial Class Registration
Dancer Information
Dancer's Name *

First Name Last Name
Birth Date *

Month Day Year
Does the dancer have any allergies, chronic illness, or medical conditions? If yes, please describe. *
Is the dancer prescribed an inhaler or any other medications? If yes, please explain any instructions. *
Please select all of the classes your dancer will be trying: *

Monday 5:15 PM Intro to MT/Jazz Monday 5:30 PM Acro Int/Adv Monday 6:45 PM Tap 1/2 Monday 6:45 PM Acro Beg/Int Monday 6:45 PM Musical Theater 3 Monday 7:45 PM Jazz 3 Tuesday 5:30 PM Musical Theater 1 Tuesday 5:30 PM Wee Hop Tuesday 5:45 PM Tap 3 Tuesday 6:30 PM Hip Hop 1 Tuesday 6:45 PM Musical Theater 2 Tuesday 6:45 PM Modern 3/4 Tuesday 7:45 PM Jazz 1/2 Tuesday 7:45 PM Musical Theater 4 Tuesday 8:45 PM Jazz 4 Wednesday 5:30 PM Ballet 1 Wednesday 5:45 PM Little Beginners Wednesday 5:45 PM Lyrical 4 Wednesday 6:45 PM Lyrical 1 Wednesday 6:45 PM Ballet 4 Wednesday 8:15 PM Contemporary 4 Thursday 5:30 PM Ballet/Tap Thursday 5:30 PM Ballet 2 Thursday 5:45 PM Lyrical 3 Thursday 6:45 PM Lyrical 2 Thursday 6:45 PM Ballet 3 Thursday 8:00 PM Contemporary 2/3 Friday 5:15 PM Tiny Tots Tumbling Friday 6:30 PM Ballet/Tap Friday 6:45 PM Hip Hop 2/3 Saturday 8:00 AM Technique 3/4 Saturday 9:30 AM Modern 2 Saturday 10:15 AM Little Beginners Saturday 10:30 AM Technique 1/2 Saturday 11:30 AM Ballet/Tap
Which week will your dancer be trying classes? *
*Please note that we are closed for Thanksgiving & Winter break. There will be no classes from 11/26-11/28 or 12/24-1/2.
Second Dancer's Information

(If you don't have a second dancer, skip to the Parent/Guardian Section)
Second Dancer's Name

First Name Last Name
Second Dancer's Birth Date *

Month Day Year
Second Dancer's Gender *

Male Female
Does the second dancer have any allergies, chronic illness, or medical conditions? If yes, please describe. *
Is the second dancer prescribed an inhaler or any other medications? If yes, please explain any instructions. *
Please select all of the classes your second dancer will be trying: *

Monday 5:15 PM Intro to MT/Jazz Monday 5:30 PM Acro Int/Adv Monday 6:45 PM Tap 1/2 Monday 6:45 PM Acro Beg/Int Monday 6:45 PM Musical Theater 3 Monday 7:45 PM Jazz 3 Tuesday 5:30 PM Musical Theater 1 Tuesday 5:30 PM Wee Hop Tuesday 5:45 PM Tap 3 Tuesday 6:30 PM Hip Hop 1 Tuesday 6:45 PM Musical Theater 2 Tuesday 6:45 PM Modern 3/4 Tuesday 7:45 PM Jazz 1/2 Tuesday 7:45 PM Musical Theater 4 Tuesday 8:45 PM Jazz 4 Wednesday 5:30 PM Ballet 1 Wednesday 5:45 PM Little Beginners Wednesday 5:45 PM Lyrical 4 Wednesday 6:45 PM Lyrical 1 Wednesday 6:45 PM Ballet 4 Wednesday 8:15 PM Contemporary 4 Thursday 5:30 PM Ballet/Tap Thursday 5:30 PM Ballet 2 Thursday 5:45 PM Lyrical 3 Thursday 6:45 PM Lyrical 2 Thursday 6:45 PM Ballet 3 Thursday 8:00 PM Contemporary 2/3 Friday 5:15 PM Tiny Tots Tumbling Friday 6:30 PM Ballet/Tap Friday 6:45 PM Hip Hop 2/3 Saturday 8:00 AM Technique 3/4 Saturday 9:30 AM Modern 2 Saturday 10:15 AM Little Beginners Saturday 10:30 AM Technique 1/2 Saturday 11:30 AM Ballet/Tap
Which week will your second dancer be trying classes? *
*Please note that we are closed on Halloween, Saturday, Oct 31st. There will be no classes that day.
Third Dancer's Information

(If you don't have a third dancer, skip to the Parent/Guardian Section)
Third Dancer's Name

First Name Last Name
Third Dancer's Birth Date *

Month Day Year
Third Dancer's Gender *

Male Female
Does the third dancer have any allergies, chronic illness, or medical conditions? If yes, please describe. *
Is the third dancer prescribed an inhaler or any other medications? If yes, please explain any instructions. *
Please select all of the classes your second dancer will be trying: *

Monday 5:15 PM Intro to MT/Jazz Monday 5:30 PM Acro Int/Adv Monday 6:45 PM Tap 1/2 Monday 6:45 PM Acro Beg/Int Monday 6:45 PM Musical Theater 3 Monday 7:45 PM Jazz 3 Tuesday 5:30 PM Musical Theater 1 Tuesday 5:30 PM Wee Hop Tuesday 5:45 PM Tap 3 Tuesday 6:30 PM Hip Hop 1 Tuesday 6:45 PM Musical Theater 2 Tuesday 6:45 PM Modern 3/4 Tuesday 7:45 PM Jazz 1/2 Tuesday 7:45 PM Musical Theater 4 Tuesday 8:45 PM Jazz 4 Wednesday 5:30 PM Ballet 1 Wednesday 5:45 PM Little Beginners Wednesday 5:45 PM Lyrical 4 Wednesday 6:45 PM Lyrical 1 Wednesday 6:45 PM Ballet 4 Wednesday 8:15 PM Contemporary 4 Thursday 5:30 PM Ballet/Tap Thursday 5:30 PM Ballet 2 Thursday 5:45 PM Lyrical 3 Thursday 6:45 PM Lyrical 2 Thursday 6:45 PM Ballet 3 Thursday 8:00 PM Contemporary 2/3 Friday 5:15 PM Tiny Tots Tumbling Friday 6:30 PM Ballet/Tap Friday 6:45 PM Hip Hop 2/3 Saturday 8:00 AM Technique 3/4 Saturday 9:30 AM Modern 2 Saturday 10:15 AM Little Beginners Saturday 10:30 AM Technique 1/2 Saturday 11:30 AM Ballet/Tap
Which week will your third dancer be trying classes? *
*Please note that we are closed on Halloween, Saturday, Oct 31st. There will be no classes that day.
Parent/Guardian Information
Name *

First Name Last Name
Cell Number *

Area Code Phone Number
Home Number

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
How did you hear about us? (If you were referred by one of our current families, please let us know who!) *
Emergency Information
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
Alt. Phone Number

Area Code Phone Number
ADC Summer Policies

Please read through the entire Policies stated below.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. I AGREE TO THE ABOVE TERMS & CONDITIONS OF ADAGIO DANCE CENTER.
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2020-21 Trial Class Registration