Please complete this
on-line Registration Form.
When finished click the
SUBMIT Button below.
2011 Summer June Tumble Camp
On-Line Registration
Gender
F
M
Birthdate:
Age:
Student Name
:
Grade
Pre-K
k
1
2
3
4
5
6
7
8
9
10
11
12
Grade:
Select The Programs and Interests You Would Like to Enroll In:
Register 2011-2012 Fall Program Registration $20.00 Required for All Students
Register 2012 Recital Fee $30.00
Check Main Interests:
Advanced K-2nd Pre-team Non-Competitive Tumble Monday 6:30 - 7:30 $45.
Dance Training (All Styles)
Ballet Only Class
2011Christmas Musical
Tumbling Only
Tumbling and Dance
June 2012 End of Year Recital
Pre-Team Program/Two days week
Tryout for 2011-2012 (New kids only)
Competitive 2012 Team Program 5 Days
Competitive 2012 Team Program 4 Days
Competitive 2012 Team Program Minimum
3 Days
3rd - 6th Grade Dance/Tumble Combo Class Mondays 7:30 - 8:30 $45.
1st - 3rd Grade Dance/Tumble Beginner Class Tuesday 3:30 - 4:30 $45.
Pre-team Ballet K-2nd Open to any student interested in competition team Tue. 4:30 - 5:15 $40./month
Pre K - 1st Grades 4-6 age Dance / Tumble Combo Class Tuesday 5:15 - 6:15 $45.
Pre-team Dance/Tumble Class by invitation only please check if interested Thur. 6:00 - 7:00
Tumbling 3rd - 6th Grades All skill Levels Thursdays 7:00 - 8:00 $45.
Three-Day Pre-Team Tumbling Monday, Tuesday, Thursday $100.00/Month
September 10th Contemporary Workshop Jasen Page Monday 3:30 - 5;00 Team only
Scheduled Classes:
Please Enter Days and Times of classes You would like to signup for:
Fall Schedule 2011
to be Updated soon
____________________________________________________________________________________________________________________
CONTACT INFORMATION
Father:
Home:
Work:
Cell:
Home:
Work:
Cell:
Mother:
Address:
Email:
Referred By:
Home Address:
How did you hear about us?
News Paper
Website
School
Sign
Other
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EMERGENCY INFORMATION
In the event of an emergency and a parent/guardian cannot be reached, please call:
Name:
Phone:
Phone:
Doctor's Name:
Insurance Company:
MEDICAL BRIEF
Child's Name:
Check ALL applicable conditions and explain.
If you have more than one child enrolled, please specify if a child has the condition on the form provided.
Please Explain:
Respiratory or Asthma:
Muscle or Bone condition:
Diabetes (Type I or II):
Heart Condition:
Is Your Child on any special medication(s)?
Any Special Precautions Tumble Express should be aware of:
Please Describe:
Other Medical Conditions or previous injuries?
Coach and Director Patty Grove
Tumble Express Gymnastics
and Acrodance
P.O. Box 1574, 107 Court Street
Huntsville, AR 72740
ph: 479-738-1037
alt: 479-530-8746
coach@tumbleexpressdance.com