REGISTRATION PACKET 2014 / 2015
Registration is on going by mail, in person during summer term Monday-Friday(9 AM – 7 PM) and Saturday
(9AM -12 PM). We offer online registration after June 18th. Please include the completed forms in this packet,
pages 1, 2, 7, & 8, signed and initialed, along with the registration fee, and the first month’s ½ tuition and
second months full tuition to hold your space in class. Your registration cannot be processed without a
completed packet and all fees.
Yearly Registration Fee is $30.00 per student, $20.00 per sibling,
□ New Student
□ Returning Student
Auto-Pay: Yes ___
How did you hear about CIARA?
Friend referred ___ Website ___ Ad ___
Student Name:
Age:
Date of Birth:
Parents’ Names:
School Attending:
School District:
Home Address:
City:
ZIP:
Mom Home Number:
Mom Cell Number:
Mom Work Number:
Dad Home Number:
Dad Cell Number:
Dad Work Number:
Emergency Contact Name:
Relationship:
Emergency Contact Phone Number:
Email is vital to communication with our families. Please print clearly:
Parent Email Address:
Student Email Address:
Office Use Only
Today’s Date: _____ /_____ /_________ Processed by
Receipt Number:
Type of Payment: ________________
© 2014 CIARA DANCE:
21250 CALIFA STREET SUITE 105A, WOODLAND HILLS, CA 91367
818.888.7744 | info@ciaradance.com
www.ciaradance.com
Total:
Registration - ADD CLASS FORM
PLEASE FILL OUT A SEPARATE FORM FOR EACH STUDENT
Student Name (print)
Parents’ Names
Home phone
Cell phone
Class
List all classes student will be attending
Instructor
Day/Time
Hours
Total Hours:
© 2014 CIARA DANCE:
21250 CALIFA STREET, STE. 105A, WOODLAND HILLS, CA 91367
818.888.7744 | info@ciaradance.com
www.ciaradance.com
2
TUITION SCHEDULE - 2014 / 2015
Yearly tuition is prorated to 10 monthly charges based on total hours per week.
Hours Per Week
Monthly Rate
Hours Per Week
Monthly Rate
¾ hour
1 hour
1 ¼ hour
1 ½ hour
1 ¾ hour
2 hours
2 ¼ hours
2 ½ hours
3 hours
3 ½ hours
4 hours
4 ½ hours
$55.00
$60.00
$71.00
$85.00
$100.00
$114.00
$117.00
$130.00
$155.00
$175.00
$190.00
$207.00
5 hours
5 ½ hours
6 hours
6 ½ hours
7 hours
7 ½ hours
8 hours
8 ½ hours
9 hours
10 hours
Unlimited
SINGLE CLASS
$225.00
$242.00
$264.00
$283.00
$294.00
$300.00
$304.00
$319.00
$324.00
$330.00
$340.00
$18.00
Optional fees:
Recital Fee and Costume fees, Company fees, Nutcracker costume fees
Our Aerial Program
Aerial is a separate program. The above tuition rates do not apply to this program. Fees for aerial must be paid
in full before the first class of each month to receive the monthly class rate, or drop-in rate applies. These rates
apply for each class in a month. Example: A month with 5 Mondays would be 125.00 monthly.
1 class per week
$25.00 per class paid monthly
2 classes per week
$23.00 per class paid monthly
3 classes per week
$22.00 per class paid monthly
Trial class
$20.00 first time visit
Drop-in Class
$30.00 per class
STUDIO POLICIES
To maintain a pleasant atmosphere, please observe the following:
• Arrive early, before your scheduled class. Late admittance is at the teacher’s discretion and not
allowed after 10 minutes. This prevents injury to the dancer and disruption to the class.
• Follow the given dress code for your class level. Wear tights, leotards, and proper dance shoes.
• Secure hair in a neat bun or pony tail off the face.
• No food or drink (other than water), is allowed in the dressing area or studios.
• No chewing gum allowed on the premises.
• Please do not talk loudly in the reception area or hallway.
• Do not wear street shoes on the dance floor.
• Do not wear dance shoes in the street.
• Office phone is available for emergency use only.
• Label all dance shoes/clothing with first and last name. Leave all valuables at home.
CIARA DANCE is not responsible for lost or stolen money, cell phones, shoes, boots, clothing, jewelry,
etc. Do not leave bags unattended in the dressing room or hallway.
© 2014 CIARA DANCE:
21250 CALIFA STREET, STE. 105A, WOODLAND HILLS, CA 91367
818.888.7744 | info@ciaradance.com
www.ciaradance.com
3
STUDIO HOLIDAYS and EVENTS
2014 / 2015 Calendar
Mark your calendars for Bring a Friend to Dance Week! Friends dance free!
Share CIARA with your friends and earn appreciation credit!
October 13-18, 2014, and February 16-21, 2015.
FIRST DAY OF CLASSES
Aug. 17
Sunday
LABOR DAY
Aug. 30-Sept. 1
Saturday - Monday
HALLOWEEN
Oct. 31
Friday
THANKSGIVING
Nov. 26-30
Wednesday - Sunday
WINTER BREAK
Dec. 22 – Jan. 3
Classes resume Sun. Jan 4th
MARTIN LUTHER KING DAY
Jan. 19
Monday
SPRING BREAK
TBA
Monday - Sunday
MEMORIAL DAY
May 23 -25
Saturday – Monday
STUDIO DRESS REHEARSAL
May 17 & May 31
Sunday
LAST DAY OF CLASSES
June 9
Tuesday
PICTURE DAY
TBA
RECITAL DRESS REHEARSAL
June 10 & 11
Wednesday and Thursday
JUNE RECITAL
Jun. 15 & 16
Saturday and Sunday
DRESS CODE
Dance clothes are required for all classes. No street clothes, street shoes, pajama bottoms, or midriff tops.
Ballet Attire includes; Girls: Pink tights, pink leather ballet shoes (with elastic). Boys: Black tights, white T-Shirt, dance belt,
white ballet shoes. Hair must be secured off the face preferably in a bun.
No costumes, tutus, hanging earrings, large necklaces, bracelets, or baggy clothing.
MOVEMENT MAGIC 2.5 - 4 YEARS
PRE-BALLET/TAP OR JAZZ COMBO
PRE-BALLET II
ELEMENTARY BALLET
BALLET I
BALLET II / III
BALLET IV
BALLET V
BALLET VI – VII
JAZZ
MODERN / DUNHAM
TAP
HIP HOP
Powder Blue Leotard
MUSICAL THEATER
AERIAL
Jazz pants, t-shirt, sneakers or jazz shoes
Powder Blue Leotard
Pink Leotard
Royal Blue Leotard
Royal Blue Leotard
Lavender Leotard
Burgundy Leotard
Black Leotard
Black Leotard
Jazz pants, leotard (color optional), black jazz shoes
Black leotard, black or tan footless tights, bare or foot thongs
Black jazz pants, leotard color optional, black leather low heel tap shoes
Jazz pants, workout type clothing, tee shirt or leotard No JEANS, SANDALS OR
FLIP-FLOPS Worn in Class
Black shorts or black leggings, black tank or black leotard, no shoes
ClASS PLACEMENT
Evaluations are mailed separately for on-going students in the ballet, jazz, and tap program. Students are evaluated each
year and placed in classes for the up-coming year. Our system is graded and based on acquired skill. It is not uncommon
to spend 2-3 years in each level to gain mastery. If you have questions or concerns about class placement please call the
office. Do not enroll in a higher level than indicated on the evaluation. New students will be evaluated during first class.
There is one free trial class for new students. Students taking single classes or drop-in classes pay the single-class rate of
$18.00.
© 2014 CIARA DANCE:
21250 CALIFA STREET, STE. 105A, WOODLAND HILLS, CA 91367
818.888.7744 | info@ciaradance.com
www.ciaradance.com
4
TUITION POLICIES 2014/2015
Tuition is based on yearly amount divided into 10 monthly installments. The yearly fee is pro-rated over 10
months regardless of number of classes in a month. Yearly tuition students pay this amount. Single class rates
apply to all others. December and June are shortened months that are offset by months with 5 classes in
them. To maintain your status as a yearly tuition student, all months in the term are due from your first
enrollment month to the end of the term.
All yearly tuition students are subject to the yearly tuition policy. Yearly tuition students benefit from the
multiple discount, as the monthly fees are less than single class fees. These fees are constant despite the
number of lessons in a month. Because of these discounts each month must be paid in full, unless the student
formally withdraws from the program. If you miss a month of payments for any reason you will lose your status
as a yearly tuition student. If you return to classes you will be charged the single class rate for the remainder of
the term. To reinstate the yearly tuition any missed month/s and a $30.00 reinstatement fee will be applied.
Please bare in mind we do not charge for months with 5 classes and you receive a lower rate than single class
rate, you gain this benefit by adhering to the yearly policy. To withdraw, written notice must be received on or
before the 22nd of the current month informing the studio of your intention to withdraw in the next month.
Tuition is due on the 22nd of each month in advance. Payments received after the 7th of the current month
are late and will incur a $15.00 late fee. There will be no exceptions to this rule. Pro-ration is available only for
the first month when enrolling at the single class rate of $18.00.
Make-up lessons are allowed when there is an excused absence (you are required to call prior to the missed
lesson). Make-ups must be taken within four weeks of the absence when available. Make-up privileges expire
after 4 weeks. No refunds, credits, extensions, or pro-rations will be given for any reason including vacations,
holidays, illness or otherwise. Please do not ask to be the exception to this policy, which we apply fairly to all.
Thank you in advance for your cooperation.
TUITION AND FEES
•
•
•
•
•
•
•
•
•
•
All payments are non-transferable and non-refundable
Tuition is due each every month from enrollment until June
Preregistration is required for all classes
Checks returned NSF will be charged a $25.00 fee
Yearly Registration Fee is $30.00 per student, $20.00 per sibling
10% discount for siblings, applies to the member taking the least number of classes
Late payments received after the 7th incur $15.00 late fee and forfeit all discounts
Only one discount may be applied at any time
Discounts do not apply to registration fees
Earn appreciation credits! For every registered referral before November 30th, you earn $15.00 towards
dancewear or classes! We appreciate your referrals.
© 2014 CIARA DANCE:
21250 CALIFA STREET, STE. 105A, WOODLAND HILLS, CA 91367
818.888.7744 | info@ciaradance.com
www.ciaradance.com
5
POLICY AGREEMENT - 2014/ 2015
I have received a copy of the 2014 /15 studio policy and current class schedule.
I agree to adhere to all studio policies as contained in this document. I also agree to follow any further policies
that may be deemed necessary throughout the year. Both parent and student should read carefully and
acknowledge with initials and signature. This includes but is not limited to the following (please initial each):
TUITION is due in advance, on the 22nd of current month. Payments made after the 7th are late. Tuition
received after the 7th must include the $15.00 late fee (no exceptions).
TUITION is a yearly fee paid pro-rated over 10 months. Payment is due each and every month
including months that contain holidays and the recital performance, this includes December and June. Failing
to pay each month from initial enrollment through the term will mean all classes will revert to the single class
rate. Your initials indicate that you agree to pay full tuition for each month from September to June unless you
withdraw completely from the program. Withdrawal from the program must be submitted in writing.
TUITION is non-refundable and non-transferable. There are no refunds, credits, or extensions given for
any reason. Make-up classes, when available, are for currently enrolled students only and must be taken within
4 weeks of missed class, and must be scheduled through the office. Make-ups will not be allowed in full
classes.
DRESS CODE to be adhered to, at all times. Please refer to the policy for your class specifics.
APPROPRIATE BEHAVIOR is expected at all times towards CIARA staff, other students, and visitors to the
school. No loud talking in the hallway, dressing room, and waiting area. No cell phone conversations in the
reception.
NO FOOD OR DRINK in the dressing room or studios. Do not bring gum on the premises.
I hereby release CIARA DANCE and all class and performance locations, as well as their owners, agents,
employees, volunteers, contractors and successors, from liability. I agree to indemnify them for and hold them
harmless from losses, suits, claims and demands of every kind and character arising out of and in conjunction
with my child’s or my own participation in these classes. I recognize and acknowledge there are certain risks of
physical injury, and I agree to assume the full risk of personal injuries, accidents, illnesses, death, damages
and/or property loss that I or my minor child may sustain as a result of participating in any activities connected
with or associated with CIARA DANCE programs, classes or private lessons.
I hereby assign all rights to videotaping, photographs and sound recordings for promotional purposes, and
authorize the reproduction, sale, copyright, exhibition, broadcast and distribution of such video, photographs
and recordings without limitation or compensation
I have read, understand and agree to abide by these policies:
X__________________________________________________ Date: _______________________
Signature Parent / Guardian
___________________________________________________ Age of Minor ________________
Student Signature (10 and above)
© 2014 CIARA DANCE:
21250 CALIFA STREET, STE. 105A, WOODLAND HILLS, CA 91367
818.888.7744 | info@ciaradance.com
www.ciaradance.com
6
MEDICAL RELEASE
I, __________________________________ authorize CIARA DANCE to provide any attention deemed necessary to my dancer,
____________________________________, in the event of a medical emergency, including but not limited to ice, bandages,
Tylenol and transportation to a medical facility, if needed.
WAIVER OF LIABILITY
Read this document carefully before signing. By signing this document you are limiting your legal rights.
Name Of Participant ___________________________________________________________________________
This Release and Waiver of Liability is executed on this date of ________________________, 20_____, by
□ participant (over 18) _________________________________________________________________________
□ parent / legal guardian (if participant is a minor) ______________________________________________
If the participant is a minor, this document is to be signed by the minor’s legal guardian (parent). By signing
below, minor's legal guardian indicates that he or she understands that the use of “I” below refers to both the
legal guardian and minor.
I wish to participate in a dance class, rehearsal, dance party or other activity at CIARA DANCE otherwise known as CIARA,
either as part of CIARA programming or as a participant of a private studio rental of CIARA’S Facilities. As a condition of
CIARA agreeing to allow me to participate in such an activity, I hereby confirm and agree to the following:
1. I recognize that the activity of the type I intend to participate in at CIARA requires physical exertion, which may be strenuous and may
cause physical injury, and I am fully aware of the risks and hazards involved.
2. I understand that it is my responsibility to consult a physician prior to and regarding my participation in any activity I attend at CIARA. I
represent that I am physically fit and have no medical condition that would prevent my full participation in any such activity.
3. I understand that CIARA is not liable for any injuries to any participant, dependent(s) or guest(s) or be subject to any claim or demand
for injury or damages whatsoever, including, without limitation, those damages resulting from acts or negligence on the part of CIARA, its
owners, agents, instructors or employees. I, and on behalf of my executors, administrators, heirs, assignees and successors, do hereby
knowingly and voluntarily forever waive, release, discharge and agree to indemnify and hold harmless CIARA, its owners, instructors,
employees, assignees and successors from all such claims, demands, injuries, damages, actions or causes of action for any injury or
damage that I may sustain as a result of my participation in an activity anywhere within the confines and under the jurisdiction of CIARA.
4. CIARA shall not be responsible to me, my dependents or guests for property damaged, lost or stolen in or surrounding CIARA confines,
including but not limited to clothing, cell phones, cash, credit cards, jewelry and any and all personal property brought to and/or left at
CIARA.
5. I agree to take full responsibility for any risks, injuries, and loss or damages known or unknown which I incur, or may incur, as a result of
participation in any activity at CIARA.
I DECLARE that I have fully read and understand this waiver and release prior to signing. I understand that I am waiving any
right I may have to assert a claim against the Released Parties.
X__________________________________________________ Date: _______________________
Signature Parent / Guardian
___________________________________________________ Age of Minor ________________
Participant
© 2014 CIARA DANCE:
21250 CALIFA STREET, STE. 105A, WOODLAND HILLS, CA 91367
818.888.7744 | info@ciaradance.com
www.ciaradance.com
7
*Automatically Generated*
Automatic Credit Card Billing Authorization Form
If you would like to enjoy the convenience of automatic billing, simply complete the Credit Card Information
section below and sign the form. All requested information is required.
Upon approval, we will automatically bill your credit card for the amount indicated and your total charges will
appear on your monthly credit card statement.
You may cancel this automatic billing authorization at any time by contacting us.
CUSTOMER INFORMATION (to be completed by merchant)
Customer name:
Customer account number:
Phone:
PAYMENT INFORMATION (to be completed by merchant)
I authorize *Automatically Generated* to automatically bill the card listed below as specified:
Amount:
Frequency: (please check only one)
$ ____________________________________________
Start billing on:
Weekly ____ Bi-Weekly ____ Semi-Monthly ____ Monthly ____
Quarterly ____ Semi-Annually ____ Annually ____
End billing when: customer provides written cancellation
________ /_________ /____________
Or
contract expires _______ /_______ /____________
CREDIT CARD INFORMATION (to be completed by customer)
*Automatically generated* accepts the following credit cards: Visa, MasterCard, American Express, and
Discover
Credit card type:
Credit card number:
_________________________
_____________
CVV CODE: ___________
_____________
Expires:
_____________
_____________
_____ _____ / _____ _____
Cardholder's name:
Cardholder's Zip code (required):
____________________________________________________________
(As shown on credit card)
_______________________________
(From credit card billing address)
X__________________________________________________ Date: _______________________
Customer Signature
All charges will appear as CIARA DANCE. I will give the studio office one month’s written notice from the 1st of
the month to discontinue these charges.
(Initials).
© 2014 CIARA DANCE:
21250 CALIFA STREET, STE. 105A, WOODLAND HILLS, CA 91367
818.888.7744 | info@ciaradance.com
www.ciaradance.com
8