37 West Center St Suite 202 One Factory Square

Southington, CT 06489 860-628-4433

dancecityct@gmail.com

Ages 3-5

4:00pm-4:45pm Monday, Wednesday, Friday

Fee for both weeks: $85.00 Included: Class Memory Book

Official Angelina Ballerina Dance Academy Angelina Skirts and Ears may be purchased in the office

Ages 5-10 and Ages 11+ 9:30am-3:00pm

Monday, Wednesday, Friday

Princess and Fantasy Tap/Jazz/Acrobatics

July 8, 10, 12 Dance in a fun and magical

environment! Dance Attire: Pink Leotard, Pink Tights,

Hair in ponytail or bun Recommended shoes:

3800 Mary Jane Carmel Tap, Capezio EJ 2 Jazz Black Slip On

Angelina Ballerina Dance Academy™

July 15, 17, 19 Read and dance along with Angelina

and her friends in this “Absolutely Positively Stupendous” class!

Dance Attire: Pink Leotard, Pink Tights, Hair in ponytail or bun Recommended shoes:

Capezio Daisy Pink Ballet

Day-Dance Camp July 15-19

Try new styles of dance including Jazz, Ballet, Hip Hop, Theater, Tap, Acrobatics, Yoga, Zumba, and more!

Program also includes: Craft, Lunch and afternoon snack, Outdoor activities, Class Memory Book Each day please bring: All Dance Shoes, sneakers, lunch and snacks, large water bottle, towel Fee for one week: $250.00 Before Care Available from 8:00am - 9:30am $75/week

Student Name:____________________________________________________Age:____Birth Date:______/______/_______

Address:______________________________________________City:_________________________ZIP:_________________

Parent’s Name’s:__________________________________________________Phone(s):_______________________________

Allergies or Disabilities (includingBehavior):____________________________________________________________________

Email:_________________________________________

PLEASE LIST THE CLASSES IN WHICH THE STUDENT IS ENROLLING (ONE APPLICATION PER CHILD): Camp Name:______________________________________________ Cost: _________________

Camp Name: _____________________________________________ Cost: __________________ Day Camp Before Care Option (8:00-9:30) $75/week □ yes □no Payment Method: □Cash □ Credit Card □Check#________ Total Amount:$_______ Tuition payment is required at the time of registration. Dance City & the Arts LLC reserves the right to cancel classes based on enrollment. Warning: Participation in dance or any other physical activity could result in injury. I understand by signing this form that I waive any right to hold Julie Rizzo or anyone affiliated with Miss Julie’s Dance City & the Arts, LLC responsible for any injuries or damage that might occur during participation of class or any event sponsored by this business. I give Dance City & the Arts, LLC permission to use photographs of my child in any ads or promotions:

Parent/Guardian Signature:______________________________________________Date:___________________________