Parent/Guardian Information: Please provide all data that differs from the Primary Contract listed. Mother: Father: Address: City, ST, Zip: Home Phone: Cell Phone:
Student Information: Name: Date of Birth: School/District: Grade: Age: Cell Phone:
Pertinent Medical Information: Are there any medical or other health factors that might affect the participant’s performance in this activity? No Yes (explain) Is the participant taking any medication that might affect his/her safety or performance in this activity? No Yes (explain)
Emergency Contact: Name: Phone: Relationship:
New Students Only: Previous Training: Please tell us where you heard about the Destiny Baton & Dance: Flyer: Studio Website: Parade or Show: Word of Mouth: Referred by: (Student, Parent, Etc.)
Classes: Please check next to the class(es) you would like to enroll in:
Monday Classes: Combo Dance - Pre-Ballet, Tap, & Baton 3-4yrs Monday 3:00pm-3:45pm: $30 per month Combo Dance & Baton - Ballet I, Tap I, & Baton I 5-8yrs Monday 4:00pm-5:00: $30 per month Hip-Hop Beg/Int 8Years & Over Monday 5:30pm-6:30pm: $30 per month Tap II Beg/Int 16yrs & Under Monday 6:30pm-7:30pm: $30 per month Dance Fitness Teen & Adult Monday 7:30pm-8:30pm: $20 per month
Wednesday Classes: Combo Dance - Pre-Ballet, Tap, & Baton 3-4yrs Wednesday 10:00am-10:45am: $30 per month Intro to Baton Kindergarten Wednesday 11:00am-11:30am: $20 per month Intro to Baton 1st-3rd Grade Wednesday 11:45am-12:30am: $25 per month Intro to Baton 4th Grade & Over Wednesday 12:45pm-1:30pm: $25 per month
Thursday Classes: Baton II Beg/Int 8-12yrs Thursday 3:15pm-4:00pm: $25 per month Baton III Int/Adv 10 & Over Thursday 4:00pm-4:45pm: $25 per month Dance Twirl Team By Audition Only Thursday 4:45pm-5:30pm: $20 per month
Friday Classes: Creative Movement 2-3yrs Friday 3:00pm-3:30pm: $20 per month Ballet II & III Beg/Int 16yrs & Under Friday 3:30pm-4:30pm: $30 per month Jazz II Beg/Int 16yrs & Under Friday 4:30pm-5:30pm: $30 per month Combo Dance - Ballet I, Jazz I, & Tap I 8-12yrs Friday 5:30pm-7:00pm: $40 per month Baton I & II Beg/Int 8-12yrs Friday 7:00pm-7:30pm: $20 per month
Saturday Classes: Daddy/Daughter Saturday 9:30am-10:30am: $20 per month (Starts in Jan.) Combo Dance & Baton - Ballet I, Tap I, & Baton I 5-8yrs Saturday 10:30am-11:30am: $30 per month Lyrical/Worship 10-16yrs Saturday 11:30am-12:15pm: $30 per month
Sunday Classes: Contemporary Instructor's Approval Required Sunday $30 per month
Private Lessons By Appointment: $20 per hour
Please read the following carefully. You will be asked to sign a hard copy before your child's first class. Students will not be permitted to take class until signed.
Liability Release: I hereby release Calvary Christian School, Destiny Baton & Dance, Tawni Daigle, or her agents or employees, heirs, successors and assign, from any liability or claim of student, or students’ parent or legal guardian, arising out of any injury or accident resulting from normal class activity or student negligence. We understand that there are inherent risks in any physical or athletic activity and that students and parents or legal guardian acknowledge this. We hereby agree to indemnify and hold harmless Calvary Christian School, Destiny Baton & Dance, Tawni Daigle, her agents or employees, successors and assign, against any liability, claim or expense including attorneys’ fees and costs, arising out of any claim or suit with respect to the actions of students while a student at the studio or any injuries or claims occurring during the study of dance at the studio.
Studio Policies: The undersigned hereby consents to the enrollment of (Student’s Name) as a student of Tawni Daigle at Destiny Baton & Dance. Such enrollment shall be subject to policies established by Destiny Baton & Dance, Calvary Christian School and Tawni Daigle. I have read the Destiny Baton & Dance studio policies, rules and dress code and agree to abide by them. I agree to be responsible for all tuition payments of the above named student. I understand that a monthly tuition is due by the 1st class of each month and will be considered late after that date and will be assessed a late fee. Should the student need to withdraw, a Withdrawal Form must be completed and turned in one month prior to withdrawal to avoid being required to pay further tuition payments. Tawni Daigle reserves the right at any time to terminate any student who fails to comply with the policies and rules of the studio. In the event of termination of enrollment any deposit shall be forfeited.
Photo Release: I understand that photos of students may be used for advertisement purposes and hereby grant permission.
By signing this you are agreeing to the terms stated therein. Signature: Date:
