Registration Form — F/W/S 2011-2012

Name:______________________________________________________________

Address:____________________________________________________________

City/Town:_________________________ Postal Code:_____________________

Telephone Number:__________________

Email Address:_____________________

Birthday: Month _______________ Day:___

Check here if this is a new email address.       Membership number 2011/12 _____________

Class [ HST must be added to the total fees.]	Fee Per Session				Payment Received
	Non Member		Full Member
Non-Performance Classes	Adult	Adult 50+	Adult	Adult 50+	Fall	Winter	Spring
Syncopation Plus	$97	$69	$87	$59
Clogging For Fun	$97	$69	$87	$59
Balletone (Fall and Winter session only)	$97	$69	$87	$59
The Double Steppers (performance optional)	$97	$69	$87	$59
Tap Basics and Beyond	$97	$69	$87	$59
Beginner Tap	$97	$69	$87	$59
Simply Tap	$97	$69	$87	$59
Zumba Gold	$97	$69	$87	$59
Performance Classes	Adult	Adult 50+	Adult	Adult 50+	Fall	Winter	Spring
Funky Jazz	$97	$69	$87	$59
Golden Girls & Guys	$97	$69	$87	$59
Gotta Sing Gotta Dance Ensemble	$97	$69	$87	$59
Taptations	$97	$69	$87	$59
Rockettes	$97	$69	$87	$59
All That Jazz	$97	$69	$87	$59
Sole Mates	$97	$69	$87	$59
Steppin'Out	$97	$69	$87	$59
Performance Classes Audition Required	Adult	Adult 50+	Adult	Adult 50+	Fall	Winter	Spring
Footnotes Jazz Troupe	$97	$69	$87	$59
Footnotes Tap Troupe	$97	$69	$87	$59
Rhythm of the Spirit	$97	$69	$87	$59
Golden Horseshoe Cloggers	$97	$69	$87	$59
Encore	$97	$69	$87	$59

Non-Performance Classes - Please indicate above which non-performance class/classes you wish to be enrolled in for the 2011 Fall Session, starts Oct. 3. Please note that HST (13%) must be added to the total fees.

  » FEES: $____________PLUS HST (13%): ____________TOTAL FEES = $____________

Please enclose a cheque for total fees made payable to JMC Productions.

Drop-in fees for non-performance classes are: Adults – $10 and Adults+50 – $8 plus HST.

Performance Classes - Please indicate above which performance class/classes you wish to be enrolled in for the 2011/2012 F/W/S Sessions. Please note that HST (13%) must be added to the total fees. Please enclose a cheque for total fees made payable to JMC Productions for the F/W/S sessions. Cheques may be post-dated January 1st and April 1st for the W and S sessions. If you wish, cheques for the Fall session classes may be dated October 1, 2011.

Costume Form (Performance Classes only)– F/W/S 2011-2012

NAME _________________________

For each performance class in which you are enrolled, please enclose two cheques: one in the amount of $70.00 dated Sep. 1, 2011 and one in the amount of $55.00 dated Feb. 1, 2012 made payable to
JMC Productions for costume deposit.

Approximate final costume cost is $130 – $140 per class plus HST. Balance owing is due upon completion and delivery of costume.

NOTE: Golden Girls and Guys and Solemates do not require a costume deposit.

Performing Class	Sep. 1/11	Feb. 1/12	Total Cost	Balance Owed	Paid in full
	$70	$55
All That Jazz
Encore
Footnotes Jazz
Footnotes Tap
Funky Jazz
GH Cloggers
GSGD Ensemble
Rhythm of the Spirit
Rockettes
Steppin' Out
Taptations

Waiver Form

I, the undersigned, personally and on behalf of my heirs, executors, administrators and assigns, hereby release and forever discharge the following:

1. The Burlington Footnotes Senior Performance Troupe Inc.
2. JMC Productions
3. All sponsors, organizers and volunteers of said organizations, their respective officers, directors, agents, representatives or successors, from any and all claims or demands that I have or my heirs, executors, administrators, assigns or any third party may have for personal injuries and property damage of any nature whatsoever, arising by reason of my participation or volunteering at any level of the organization's programs and productions.

I have read the above Statement, understood it and my signature confirms its acceptance. I attest and verify that I have full knowledge of the risks involved in my participation and I am physically fit and able to participate in said programs and productions.

Signature: __________________________________ Date: ____________________

Witness Signature _______________________

Medical Information (i.e. allergies, medications, conditions, etc.): ________________

_____________________________________________________________________

_____________________________________________________________________

Remember, classes may be cancelled if there is insufficient enrollment, so please register early to ensure availability. Registration cutoff for performance classes is September 30, 2011.

Please send completed forms to:

www.burlingtonfootnotes.com