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2017/2018 Full Season
2017 Fall Session
Date of Birth (DD/MM/YYYY)
Secondary Parent/Guardian Information
Address same as above
2017/2018 Full Season Classes (35 weeks)
2017 Fall Session** (10 weeks)
2018 Winter Session** (10 weeks)
2018 Spring Session** (10 weeks)
Please choose all that sessions that apply.
**Adult, Hip Hop and Move with Me classes only
Tiny Dancers (pre-ballet ages 3 & 4)
Tiny Tappers (pre-tap ages 3 & 4)
Ballet (ages 5 and up)
Pointe & Pre-Pointe (level 5 and up)
Tap (ages 5 and up)
Jazz (ages 5 and up)
Acro (ages 6 and up)
Musical Theatre (class)
Hip Hop (ages 7 and up)
Little Theatre Company (ages 8-16)
Little Theatre Company Jr. (Ages 6-10)
Move with Me 1 (mom and baby 0-10 months)
Move with Me 2 (parent and toddler (18 months - 3 years)
Please choose all classes that apply.
Preferred Day and Time:
Please let us know what day and time would prefer your classes and we will do our best to accommodate you.
Emergency Contact Name
Emergency Contact Number
Is there anything we should know about the dancer such as allergies and/or injuries?
By signing below, you agree to the following:
There are no refunds for missed classes; however, students may take a make-up class during another time slot as the schedule permits. Please speak with your teacher for available make-up times.
I hereby certify that my child is in good physical condition and is able to participate fully in this program. All current medical conditions or concerns have been indicated above. I understand the inherent risk involved in the physical activity of dancing and I release Belle Pointe Dance & Movement Company and its teachers and staff from any and all liability in the event of accident or injury. I understand that all classes will be conducted in the safest possible manner by trained professional instructors.
Belle Pointe Dance & Movement Company will not be held responsible for any damages to or theft of personal property while using the studio facilities or while participating in school functions.
I have read, understood, and agree to all of the conditions listed above.
(Parent/guardian must be 18 years of age or older)
I have read, understood, and agree to all the conditions listed above.
We are very proud of our dancers and their accomplishments and love to document their progress. Pictures may be taken of during special events and performances and these pictures may be used for promotional use and advertising. We respect your privacy, if you do not want to have your or your child's photo taken please indicate wishes below.
Please select from the following:
I do not wish to have my photo taken
I do not wish to have my child' photo taken
Your registration is almost done! A BPD representative will review your registration application and send you a confirmation that will include your class day(s) and times(s), and payment options. Thank you for choosing Belle Pointe Dance & Movement Company.
To ensure that you receive a speedy reply please be sure to add
to your email contacts or safe senders list.
Dance with your heart and your feet will follow
4056 Meadowbrook Dr #118, London ON