Student Registration Form Student Registration FormPlease complete and submit to register your child for all relevant dance classes. Each child will need to be registered separately. If attending more than four different classes, please select the Intermediate Pupil Programme which is charged at a flat rate of £210 per term. For four or less classes, the first two are charged at full price, the third and fourth at £34 each per term.Please enable JavaScript in your browser to complete this form.Student Name *FirstLastStudent's Date of Birth *Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeParent/Guardian Name *FirstLastRelationship to Student *SelectMotherFatherLegal GuardianParent/Guardian Contact Telephone Number *Parent/Guardian Contact Email *Registration confirmation will be sent to this email addressCLASSES First Class (Full Price)Pre-primary Ballet (2 1/2-4 yrs) - Saturday - £ 54.00Pre-primary Ballet (2 1/2-4 yrs) - Tuesday - £ 54.00Pre-primary Ballet & Tap - Tuesday - £ 66.00Primary Ballet (5 yrs +) - Saturday - £ 66.00Primary Ballet (5 yrs +) - Tuesday - £ 66.00Primary Ballet & Pre-Primary Tap - Tuesday - £ 78.00Grade 1 Ballet - Saturday - £ 66.00Grade 1 Ballet - Wednesday - £ 66.00Grade 2 Ballet - Saturday - £ 66.00Grade 2 Ballet - Wednesday - £ 66.00Grade 3 Ballet - Tuesday - £ 66.00Grade 4 Ballet - Wednesday - £ 66.00Grade 5 Ballet - Wednesday - £ 78.00Grade 6 Ballet & Pointe - Thursday - £ 78.00Grade 7 Ballet - Wednesday - £ 78.00Grade 8 Ballet/Intermediate Ballet - Thursday - £ 78.00Advanced Ballet - Thursday - £ 78.00Junior Street Jazz (6yrs +) - Monday - £ 54.00Street Jazz (over 12s) - Monday - £ 66.00Senior Jazz - Monday - £ 54.00Junior Jazz & Tap - Wednesday - £ 54.00Grade 2 Tap (8 yrs +) - Monday - £ 54.00Grade 3 & 4 Tap - Monday - £ 54.00Grade 3 Modern - Monday - £ 54.00Intermediate Modern - Monday - £ 54.00Jazz/Modern (8yrs +) - Tuesday - £ 54.00Commercial Jazz - Tuesday - £ 66.00Musical Theatre (6yrs +) - Thursday - £ 66.00Contemporary Dance (10yrs +) - Saturday - £ 78.00AcroDance Primary & Level 2 (4-7 rs) - Thursday - £ 66.00AcroDance Levels 3 & 4 (8-11 yrs) - Thursday - £ 66.00NB: Select ballet disciplines first if attending more than one class (another selection box will appear after each class is chosen up to a maximum of 4). If selecting more than 4 classes please select the Intermediate Pupil Programme below instead of completing this section.Second ClassSecond Class (Full Price)Grade 2 Ballet - Saturday - £ 66.00Grade 2 Ballet - Wednesday - £ 66.00Grade 3 Ballet - Tuesday - £ 66.00Grade 4 Ballet - Wednesday - £ 66.00Grade 5 Ballet - Wednesday - £ 78.00Grade 6 Ballet & Pointe - Thursday - £ 78.00Grade 7 Ballet - Wednesday - £ 78.00Grade 8 Ballet/Intermediate Ballet - Thursday - £ 78.00Advanced Ballet - Thursday - £ 78.00Junior Street Jazz (6yrs +) - Monday - £ 54.00Street Jazz (over 12s) - Monday - £ 66.00Senior Jazz - Monday - £ 54.00Junior Jazz & Tap - Wednesday - £ 54.00Grade 2 Tap (8 yrs +) - Monday - £ 54.00Grade 3 & 4 Tap - Monday - £ 54.00Grade 3 Modern - Monday - £ 54.00Intermediate Modern - Monday - £ 54.00Jazz/Modern (8yrs +) - Tuesday - £ 54.00Commercial Jazz - Tuesday - £ 66.00Musical Theatre (6yrs +) - Thursday - £ 66.00Contemporary Dance (10yrs +) - Saturday - £ 78.00AcroDance Primary & Level 2 (4-7 rs) - Thursday - £ 66.00AcroDance Levels 3 & 4 (8-11 yrs) - Thursday - £ 66.00Third classThird Class (flat fee of £34)Grade 3 Ballet - Tuesday - £ 34.00Grade 4 Ballet - Wednesday - £ 34.00Grade 5 Ballet - Wednesday - £ 34.00Grade 6 Ballet & Pointe - Thursday - £ 34.00Grade 7 Ballet - Wednesday - £ 34.00Grade 8 Ballet/Intermediate Ballet - Thursday - £ 34.00Advanced Ballet - Thursday - £ 34.00Junior Street Jazz (6yrs +) - Monday - £ 34.00Street Jazz (over 12s) - Monday - £ 34.00Senior Jazz - Monday - £ 34.00Junior Jazz & Tap - Wednesday - £ 34.00Grade 2 Tap (8 yrs +) - Monday - £ 34.00Grade 3 & 4 Tap - Monday - £ 34.00Grade 3 Modern - Monday - £ 34.00Intermediate Modern - Monday - £ 34.00Jazz/Modern (8yrs +) - Tuesday - £ 34.00Commercial Jazz - Tuesday - £ 34.00Musical Theatre (6yrs +) - Thursday - £ 34.00Contemporary Dance (10yrs +) - Saturday - £ 34.00AcroDance Primary & Level 2 (4-7 yrs) - Thursday - £ 34.00AcroDance Levels 3 & 4 (8-11 yrs) - Thursday - £ 34.00Fourth ClassFourth Class (flat fee of £34)Grade 4 Ballet - Wednesday - £ 34.00Grade 5 Ballet - Wednesday - £ 34.00Grade 6 Ballet & Pointe - Thursday - £ 34.00Grade 7 Ballet - Wednesday - £ 34.00Grade 8 Ballet/Intermediate Ballet - Thursday - £ 34.00Advanced Ballet - Thursday - £ 34.00Junior Street Jazz (6yrs +) - Monday - £ 34.00Street Jazz (over 12s) - Monday - £ 34.00Senior Jazz - Monday - £ 34.00Junior Jazz & Tap - Wednesday - £ 34.00Grade 2 Tap (8 yrs +) - Monday - £ 34.00Grade 3 & 4 Tap - Monday - £ 34.00Grade 3 Modern - Monday - £ 34.00Intermediate Modern - Monday - £ 34.00Jazz/Modern (8yrs +) - Tuesday - £ 34.00Commercial Jazz - Tuesday - £ 34.00Musical Theatre (6yrs +) - Thursday - £ 34.00Contemporary Dance (10yrs +) - Saturday - £ 34.00AcroDance Primary & Level 2 (4-7 yrs) - Thursday - £ 34.00AcroDance Levels 3 & 4 (8-11 yrs) - Thursday - £ 34.00Intermediate Pupil Programme Intermediate Pupil Programme - £ 210.00This programme is for students who wish to attend multiple classes at a flat rate of £210 per termSelect the classes student will attend within the Intermediate Pupil ProgrammeGrade 2 Ballet - Saturday*Grade 2 Ballet - Wednesday*Grade 3 BalletGrade 4 BalletGrade 5 BalletGrade 6 Ballet & PointeGrade 7 BalletGrade 8 Ballet/Advanced BalletIntermediate BalletContemporary DanceJunior Street Jazz (6yrs +)Street Jazz (over 12s)Senior JazzJunior Jazz & Tap - WednesdayJazz/Modern (8yrs +) - TuesdayGrade 3 ModernIntermediate ModernGrade 2 TapGrade 3 & 4 TapCommercial JazzMusical TheatreAcroDance Levels 3 & 4 (8-11 yrs) * Select EITHER Saturday OR Wednesday class if choosing Grade 2 BalletTotal Cost Per Term£ 0.00An invoice for this amount will be emailed at the beginning of each term. For new students who register mid-term, the invoice will be adjusted pro rata.Alternative Emergency Contact (Relative or Friend) *FirstLastAlternative Emergency Contact Telephone Number *Doctor's Name and Surgery Address *Doctor/Surgery Telephone Number *Allergies and Health ConditionsParental/Guardian Consent to Photography/Video *I agree that photographs/videos may be taken of my child during lessons, exams or performances for use by Katharine Mitchell School of DanceI DO NOT agree that photographs/videos may be taken of my child during lessons, exams or performances for use by Katharine Mitchell School of DanceBy consenting you will be agreeing that any photos or videos taken by Katharine Mitchell School of Dance may be used by the school for advertising and social media purposes.Submit