| Name: | ______________________ | ____________________ |
|
Registration Form 2005 |
| first name | last name |
| Phone: | _________________ , | __________________ , | ________________ |
| home | business | cell |
| E-Mail: | ___________________________________ |  Male or
Female |
| Address: | _________________________ , | _____ , | _____________ , | _________ |
| street | apt/suite | city | postal code |
| How did you find us (if new student)? (circle one) | Web search | Flyer | Referral | Business card |
Privacy Information: The above information is kept confidential by Toronto Dance Inc. The e-mail address will only be used for dance-related information (e.g., class information, Toronto Dance parties/outings/events).
| Cost: |
$66/p for 6 hours over 6 weeks ($11/h) for new students.
$99/p for 9 hours over 9 weeks ($11/h) for new students.
$90/p ($10/h) for past Toronto Dance students. $63 when repeating. Check with us for further discounts when you register for two or more different Toronto Dance classes (for new students only). |
| Classes: | Eastminster United Church, 310 Danforth Ave. (Danforth & Chester area) | |||
| ü | WEDNESDAYS, Apr 27 - Jun 1 (6 hours/6 weeks) | |||
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Swing level 1 | $ _____ 7:00 - 8:00pm ($66/p) | ||
| ü | WEDNESDAYS, Apr 6 - Jun 1 (9 hours/9 weeks) | |||
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Swing level 2 | $ _____ 7:00 - 8:00pm ($90-$99/p) | ||
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West Coast Swing level 2 | $ _____ 8:00 - 9:00pm ($90-$99/p) | ||
By signing this form,
I understand that Toronto Dance Inc. or its employees/contractors/helpers are not held responsible for any loss or theft of articles on the premises and are not held liable for injury or health risk sustained in the dance classes or any dance outings organized by Toronto Dance. I have read and understood the above "Privacy Information" section. I allow pictures to be taken for promotional reasons.
Signature: _____________________________________ , ___________ 2005 (date)
Pay by cash or cheque (payable to “Lynn Wilsher”).
Send (do not fax) reg form and cheque to:
Toronto Dance, Suite 3107, 38 Elm St., Toronto, ON. M5G 2K5