DANCE DIRECTIVE WORKSHOP APPLICATION

DANCE DIRECTIVE 2009

PLEASE PRINT, FILL OUT, AND MAIL THE FOLLOWING REGISTRATION FORM
WITH DOWN PAYMENT TO:

DANCE DIRECTIVE
C/O Jill Readel
1391 Grand Pointe Blvd.
West Dundee, Il. 60118
(847) 381-1459 Ext. 2
jillreadel@comcast.net

                                       WORKSHOP COST BREAKDOWN:

     MAIN CAMP:               $465.00 TOTAL ($200 min. down payment, balance due July 1)
                                                                 $485 due after June 1
     BALLET INTENSIVE:   $150.00 TOTAL ($100 min. down payment, balance due July 1)
     BOTH WORKSHOPS: $550.00 TOTAL ($200 min. down payment, balance due July 1)

Make checks payable to:
DANCE DIRECTIVE

REGISTRATION DOWN PAYMENT DEADLINE
JUNE 1, 2009

down payment is due with registration form to secure
a position in the workshop
(Any registration forms and down payments received after deadline
will be subject to enrollment availability)

Balance of full payment due:
July 1, 2009
down payments are non-refundable.

Please print out form and fill out completely:

I want to attend (please check): Main Camp ____ Ballet Intensive ____ Both ____

STUDENT NAME __________________________________________________________

ADDRESS ________________________________________________________________

CITY ___________________________________ STATE ______ ZIP ________________

PHONE _____________________________ STUDIO NAME _______________________

SCHOOL GRADE IN FALL 2009 _______

COMPLETE EMAIL ADDRESS ________________________________________________

CS CM CL AS AM AL AXL

(SHIRTS ARE NOT EXCHANGEABLE. PLEASE ORDER CORRECT SIZE!)

MEDICAL/MODEL RELEASE FORM

I/We hereby agree to hold harmless the producers of Dance Directive 2009,
The Windy City Dance Camp, Bataille Academie, Barrington High School, the photographer and videographer or any person acting under the permission of the videographer from any and all claims of injuries sustained while participating in any class or activity associated with this workshop. I give permission for my child to be photographed and/or videotaped. These photographs or videos can be used for promotional products, without further compensation.