DANCE AT NEIU
The Northeastern Illinois University Department of Music and Dance Program
The Ruth Page Dance Series, and Community Dance Program
6 Week Summer Session: June 28-August 6, 2016
Class
Creative Movement/
Pre-Dance I
Age
3-4
Day
Saturday
Time
9-9:45am
Class
Jazz Dance for
Kids
Age
8-11
Day
Tuesday
Time
5:45-7pm
Creative Movement/
Pre-Dance II
5-7
Saturday
9:4510:45am
Teen/Adult
Ballet II
14 and
up
Thursday
7:158:45pm
Ballet I
8-12
Wednesday
5:006:15pm
Yoga
12 and
up
Wednesday
6:307:45pm
Ballet II
10-14
Thursday
5:45-7pm
Musical Theater
Dance
12 and
up
Tuesday
7:158:30pm
Cost per Course (6 classes): $66
There is a 10% discount for registering one student for two courses, a 15% discount for three or more
courses. Payment is due by the first class.
All classes are held in the Fine Arts Building room FA-141.
For additional information contact Rachel Burton at 773/442-5941 or R-Burton@neiu.edu.
Forms can be returned via e-mail to R-Burton@neiu.edu, mailed to: NEIU Dance Program, 5500 N. St.
Louis Ave., Chicago, IL, 60625. Attn: Rachel Burton or faxed to 773.442.5910.
To Register, please use check boxes above to select classes and fill in the form below.
Please use one form for each registrant.
Name: ________________________________ Age: __ Date of Birth: __________ mm/dd/yyyy
Address: _____________________________________ Phone: _______________
City, State, Zip: _________________________ E-Mail: _______________________________
___________________________________________________________
Signature of Parent or Guardian, or Participant (if 18 years of age or older)
Policiesr
All dance program policies and guidelines are enacted to create a safe environment in which students can learn and have fun.
Questions regarding these policies may be directed to the program coordinator. By completing this registration form, all
participants and guardians agree to the following:
1. Registration is required of all participants and must include current information, as
well as agreement to all terms and conditions for participation.
2. Attendance is required of all participants in order to receive the full--‐benefit of the instruction. Missed classes may be
made up during the current term. Students are strongly encouraged to make up missed classes by consulting with the
teacher.
Community Dance Program – CLASS REGISTRATION
Use one form for EACH registrant. Multiple classes may be selected.
3. Payment in full for each student is due on the first day of classes. Refunds are not issued after the first week of classes.
New students will be assessed by the teacher to determine whether the class is appropriate for the age and ability of the
student. The teacher's determination is final.
4. Proper attire is required of all students. This includes: ballet slippers and jazz
shoes, leotards, tights, leggings, or tight fitting workout clothing. For safety reasons, no "street clothing," baggy clothes or
street shoes are allowed. No jewelry, such as necklaces and bracelets are permitted. Hair must be secured back from the
face.
5. Food, gum and drinks (except water) are prohibited inside the studio. Cell phone/electronic device use during class is
not allowed. Students breaking these rules will be asked to leave.
6. Other: children under the age of 13 who are enrolled in Jazz or Hip Hop are required to be in a ballet class. Courses
with fewer than 8 students enrolled may be cancelled. Parking on campus requires the purchase of a permit. Permit
dispensers are located inside the north entrance of the parking facility or in Lot H.
RRelease and Waiverr
I (participant) have elected to participate in the Community Dance Program (the Program) at Northeastern Illinois
University (NEIU). By submitting this registration, I understand that I am agreeing to voluntarily assume all responsibility
for any risks of loss, property damage, or personal injury that may be sustained as part of this participation. I hereby
covenant not to sue the Northeastern Illinois University Board of Trustees, the State of Illinois, and their officers, agents,
employees, or volunteers; and release, waive, and discharge any and all liability, claims, demands, actions and causes of
action whatsoever arising out of, or related to any loss,
damage, or injury that may be sustained by me or to any property belonging to me, while participating in the
Community Dance Program.
I further understand that NEIU may photograph or record participants in the Community Dance Program and that these
images and recordings will be used in future promotion of the program. I hereby grant NEIU, or anyone authorized by
NEIU, the irrevocable and unrestricted right to use, reproduce, and publish, in print or electronic format, any and all
images which may be taken of me as a participant in the Community Dance Program for any publicity purpose without
compensation to me. I hereby waive my right to inspect or approve the finished product; including but not limited to,
written copy and/or posting images on websites
that may be created in connection therewith. I hereby release NEIU from all claims and liability relating to said images. All
negatives and positives, together with the prints, are owned by NEIU. I understand that NEIU cannot control the use of my
name or image once such name or image is published.
I am 18 years of age or older and have read and understand the program policies and terms of this release.
I am the parent or legal guardian of a participant who is younger than 18 years of age. I have read and understand the program
policies and terms of this release.
_____________________________________________________________
Signature (parent or participant of age)