Class Registration

Name of Student *

First Name

Last Name

Student's Date of Birth *

MM

DD

YYYY

Name of Parent/Guardian *

First Name

Last Name

Home phone number *

(###)

###

####

Cell phone number

(###)

###

####

Name of other parent/guardian

First Name

Last Name

Phone number for other parent/guardian

(###)

###

####

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Choose class(es) *

Note: Classes marked with ** are appropriate for those new to highland dancing

3:45-4:45pm Monday: Intermediate/Premier Zoom class

5-6pm Monday: Returning Primaries and Beginners (ages 5+)

6-7:15pm Monday: Intermediate/Premier

5:30-6pm Tuesday: New Primaries (ages 4-6)**

6-7pm Tuesday: Advanced Pre-Premier (ages 7-11)

5-6pm Wednesday: Returning Primaries (ages 5+) and New Beginners (ages 7+)

6-7:15pm Wednesday: Intermediate/Premier

5-6pm Thursday: Intermediate/Premier Zoom class

6-7pm Thursday: Advanced Pre-Premier (ages 7-11)

Other (private/semi-private lessons)

Photo/video consent *

I sometimes post pictures and video of my students on my official Facebook page and website to both promote my classes and share our dance school's news with friends, family and the general public. However, I am mindful of those who prefer not to appear in social media posting and the internet. Do you consent to your child's photo and/or video appearing on the Marielle Lesperance Dance public Facebook page and/or website? (if you have any special requests concerning posting, please let me know in the "additional comments" section below)

Yes

No

School Policies *

I have read and understand both the regular and temporary COVID-19 school policies (please contact Marielle for the full list of temporary COVID-19 policies through the contact page). I agree to follow these policies, and understand that failure to follow them may result in removal from class, in which case no refund will be issued.

Yes

No