| Name: | ______________________ , | ____________________ |
|
Registration Form 2004 |
| last name | first name |
| Phone: | _________________ , | __________________ , | ________________ |
| home | business | cell |
| E-Mail: | ___________________________________ |  Male or
Female |
| Address: | _________________________ , | _____ , | _____________ , | _________ |
| street | apt/suite | city | postal code |
| How did you find us (if new student)? (circle one) | Web search | Flyer | Referral | Business card |
Privacy Information: The above information is kept confidential by Toronto Dance Inc. The e-mail address will only be used for dance-related information (e.g., class information, Toronto Dance parties/outings/events).
| Cost: |
$115/p for 10 hours over 10 weeks ($11.50/h).
$13/person/h for a drop-in/try-out class. |
| Classes: | Ritmo Flamenco Dance Studio, 294 College St. West | ||
| ü | SATURDAYS, Jan 10 to Mar 13, 2003 (1-hour/class for 10 weeks) | ||
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Irish Children A | $ _____ 11:00 - 12:00pm | |
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Irish Children B | $ _____ 12:00 - 1:00pm | |
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Irish Step | $ _____ 1:00 - 2:00pm | |
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Irish Basic Technique | $ _____ 2:00 - 3:00pm | |
By signing this form,
I understand that Toronto Dance Inc. or its employees/contractors/helpers are not held responsible for any loss or theft of articles on the premises and are not held liable for injury or health risk sustained in the dance classes or any dance outings organized by Toronto Dance. I have read and understood the above "Privacy Information" section. I allow pictures to be taken for promotional reasons.
Signature: _____________________________________ , ___________ (date)
Pay by cash or cheque (payable to “Anna Marie Leonard”).
Send registration form and cheque to:
Toronto Dance, Suite 3107, 38 Elm St., Toronto, ON. M5G 2K5