Pure Energy Dance Registration Form

Dancer's First Name *
Dancers Last Name *
Dancers E-mail Address
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Home Phone Number *

###
-
###
-
####
Students Cell Number

###
-
###
-
####
Students Birthday

DD
/
MM
/
YYYY
Mothers Name
Prefix
First
Last
Suffix
Fathers Name
Prefix
First
Last
Suffix
Parents Email
Parents Phone Number

###
-
###
-
####
Parents Cell Number

###
-
###
-
####
Emergency Contact name *
Emergency Contact Phone Number *

###
-
###
-
####
Alberta Health Care #
Medical Information:
Please describe any allergies, injuries, asthma, or medical conditions that might impair dance functions:
Payment

Recreational Program

 Baby and Me 2 - 3 yr Tuesday 5:15 - 6:15 
 Tiny Toes ages 3 - 4 yr Wed 5:15 - 6:15 
 Tiny Toes 3 - 4yrs Sat 11 - 12 
 Happy Feet 4 - 6 yr Wednesday 6:15 - 7:15 
 Happy Feet 4 -6 yrs Sat 12 - 1 
 Rec Jazz 6+yrs Tues 6:15 - 7:15  
 Rec Jazz 6+ Sat 1:00 - 2:00 
 Rec Contemp 8+ Tues 7:15 - 8:15 
 Rec Hip Hop 6+ Thurs 6:15 - 7:15 
 Rec Hip Hop 6+ Sat 12:00 - 1:00 

Competitive - Junior Classes

To Compete in Jazz you must be enrolled in Ballet and Acro
 Junior Acro 6+ years of age 
 Junior Ballet 6+ years of age 
 Junior 1 Tap 6+ years of age 
 Junior 1 Jazz 6+ years of age 
 Competive Hip Hop 6+ years of age 

Competitive Program Elementary

To compete in Ballet you must be enrolled in 2 Ballet classes per week and Tech and Stretch

To compete in Jazz you must be enrolled in Jazz, Ballet Tech, Acro and Tech and Stretch

To participate in Lyrical you must be enrolled in Lyrical, Ballet Tech, Acro and Teach and Stretch. Lyrical is a non competitive class for Elementary dancers
 Elementary 2 Acro 
 Elementary 2 Ballet Tech 
 Elementary 2 Ballet Comp 
 Elementary 2 Jazz 
 Elementary 2 Tap 
 Elementary 2 Lyrical  
 Elementary 2 Hip Hop 
 Elementary Tech 

Competitive Program Pre Inter

To compete in Ballet you must be enrolled in 2 Ballet classes per week and Tech and Stretch

To compete in Jazz you must be enrolled in 2 Jazz classes per week, Ballet Tech, Acro and Tech and Stretch

To compete in Lyrical you must be enrolled in Lyrical, Ballet Tech, Acro and Teach and Stretch

To compete in Contemporary you must be enrolled in Contemporary, Ballet Tech, Jazz Tech, Acro and Tech and Stretch
 Pre Inter Acro 
 Pre Inter Tech 
 Pre Inter Ballet Comp 
 Pre Inter Ballet Tech 
 Pre Inter Jazz Tech 
 Pre Inter Jazz Comp 
 Pre Inter Tap Tech 
 Pre Inter Tap Comp 
 Pre Inter Lyrical 
 Pre Inter Contemp 
 Pre Inter Hip Hop  

Competitive Program Inter Advanced

To compete in Ballet you must be enrolled in 2 Ballet classes per week and Tech and Stretch

To compete in Jazz you must be enrolled in 2 Jazz classes per week, Ballet Tech, Acro and Tech and Stretch

To compete in Lyrical you must be enrolled in Lyrical, Ballet Tech, Acro and Teach and Stretch

To compete in Contemporary you must be enrolled in Contemporary, Ballet Tech, Jazz Tech, Acro and Tech and Stretch
 Inter / Advanced Acro 
 Inter / Advanced Tech 
 Inter / Advanced Hip Hop 
 Inter / Advanced Ballet Tech 
 Inter / Advanced Ballet Comp 
 Inter / Advanced Jazz Tech 
 Inter / Advanced Jazz Comp 
 Inter / Advanced Tap Tech 
 Inter / Advanced Tap Comp 
 Inter / Advanced Lyrical 
 Inter / Advanced Contemp 

Competitive Dancer - Cash Calendar

As a competitive Dancer I am interested in participating in the Cash Calendar ticket sale and understand that I am responsible for the minimum ticket sales to cover the payouts above my mandatory fundraising amount. Should I not achieve my fundraising commitment as stated in the handbook the difference will be invoiced to my account and due March 1.
I wish to participate in the Cash Calendar Raffle Sales

Adult Classes

 Adult Aerial Fitness Monday 7:15 - 8:15 
 Adult Ballet Monday 8:15 - 9:15 
 Adult Barre Tues 8:15 - 9:15 
 Adult Contemporary Tues 8:15 - 9:15 
 Adult Jazz Wed 7:15 - 9:15 
 Adult Tap Wed 7:15 - 9:15 
 Adult Ariel Fitness Sat 9 - 10 a.m 
 Adult Barre Saturday 10 - 11 am 
How did you hear about us
Comments
Image Verification
captcha
Please enter the text from the image:
[Refresh Image] [What's This?]