Cantarella School of Dance –Summer Registration Form 2017
Student’s Name
Date of Birth
Address
City
State
Zip
Name of Parent/Guardian
Home Phone
Cell Phone
Emergency Contact and Phone Number
Email:
________________________________________________
Previous Dance Instruction
How Long?
How did you hear about us?
Allergies
* Due to the increasing number of food allergies, we ask that you do not pack your child peanut butter sandwiches *
Day Themed Camps (Please Circle Camp)
Magic Garden - $165
Storybook - $180
Intensives: (Please Circle) Discounts are available for multiple weeks
Olivia Wilber
$400 Early Bird by May 6th $385
Anna Acker/Danielle Price
$400 Early Bird by May 6th $385
Deirdre Duffin Swindlehurst (Cinderella)
$300 Early Bird does not apply
Karyl Bell (Dance Team Camp)
$245 Early Bird does not apply
Two Week Performance Workshop (Albany)
$800 plus $30 for Jacob’s Pillow Trip
Paula Weber (Albany)
$400 Early Bird by May 6th $385
Anna Acker/Chrissy Geren (Albany)
$400 Early Bird by May 6th $385
Lisa McBride (Albany)
$400 Early Bird by May 6th $385
Evening Classes
July 11 – August 12:
(Please circle and see brochure for times)
Pre Ballet I/II Tuesday $63.00
Intro Ballet Tuesday $72.00
Tap Ages 7-11 Tuesday $72.00
Elem Ballet Wednesday $72.00
Modern Wednesday $72.00
Int/Adv Ballet & Pointe Wednesday $92.00
Tap Ages 12 & Up Friday $72.00
Jazz Friday $72.00
Lyrical Friday $72.00
Tuition Amount Total
$20 Summer Registration Fee
Summer Total Payment Due
Registration fee, tuition and form should be mailed to:
Cantarella School of Dance 116 Fenn Street, Pittsfield, MA 01201
Neither Cantarella School of Dance nor its employees are responsible for personal injuries, damaged or lost personal
property. I give the Cantarella School of Danced permission to use dance photos of my child for advertising purposes
including newspapers, the school’s web and Facebook pages and emails. I also understand the school’s policies as
outlined and that I am responsible for tuition payments as described in the brochure.
Classes are dependent upon sufficient registration.
Signature of Parent / Guardian
Date