"Come create and polish yourself and help celebrate the arts!"
For more information please call (716) 822-0771, or e-mail Stacy at dancestace@
roadrunner.com
Please print and send in to performing arts center, 174 Orchard Park Road, West Seneca, NY 14224.
STACY ZAWADZKI’S PERFORMING ARTS CENTER (ZPAC) September 2009-June 2010 Registration Form
Child’s or Adult’s Name_______________________________________________
Parent or Guardian’s Name______________________________________________
Address:____________________________________________
City/State/Zip:________________________________________
E-mail Address:______________________________________
Home Phone:__________________
Work Phone:__________________
Cell Phone:____________________
Emergency Contact and Phone Number:___________________
Person in charge of picking up or dropping off child (Please write all names)
___________________________________________________
(For your child’s safety please provide a photo ID, when picking up or dropping off- ages 3-12 years of age).Child’s/Adult’s Age as of September 1st___________Birth Date_________________
Where did you hear about us?____________________________________________
Previous Dance Experience? YES NO (circle one)
Previous Acting Experience? YES NO
Previous Vocal Experience? YES NO
Previous Yoga Experience? YES NO
Previous Physical Training? YES NO
If yes, please state the number of years studied, where dance, voice, or acting was studied and what subjects were studied: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
We offer the following courses in September:
(Circle the courses you will be taking)
Tiny Tot Combo Class- Mon./ Sat.
Technique: Int. or Adv. (10-adult)
Ballet: Beg., Int., Adv.(6-adult)
Acting/Perf./Script/Resume(8-adult)
Pointe: Beg-*NEW, Int./Adv. (10-adult)
*NEW-Partnering: (12-adult)
Musical Theatre: Beg. or Int/Adv. (6-adult)
Yoga: Beg., Int., Adv.
Jazz: Beg., Int., Adv. (6-adult)
Gymnastic Floor Routine
Tap: Beg., Int., Adv.(6-adult)
ZPAC Company Team
Acro: Beg./Int. (6-adult)
ZPAC CompetitionTeam
Lyrical: Int., Adv. (10-adult)
Private Voice
Hip Hop: Beg., Int. ,Adv. (6-adult)
Private dance (must be approved)
Modern: Beg./Int.,Adv. (8-adult)
*NEW-Cardio Mix/Pilates/Yoga (Teen-Adult)
Please circle what time is good for you for Voice Lessons: (You may choose 15 minute slot, half hour slot or an hour slot):
Thursdays: 4-4:30, 4:30-5, 5:30-6, 6-6:30, 6:30-7, 8-8:30
Tuesdays: 4-4:30, 4:30-5, 5-5:30, 5:30-6, 6-6:30, 6:30-7, 7-7:30, 7:30-8
Wednesdays: 4-4:30, 4:30-5, 5-5:30, 5:30-6, 6-6:30, 6:30-7, 7-7:30, 7:30-8
(Can work with your schedule and different evenings, just ask)!
Please circle what time is good for you for Private Dance Solos (Must be approved by owner):
Mondays: 3-3:30, 3:30-4
Wednesdays: 3-3:30, 3:30-4, 9-9:30
Thursdays: 9-9:30
Saturdays: 2:45-3:15, 3:15-3:45, 3:45-4:15, 4:15-4:45, 4:45-5:15
Please circle what time is good for you for Private Acting Lessons (You may choose half hour or hour slot):
Saturdays: 10-10:30, 10:30-11, 11-11:30, 12:45-1:15, 1:15-1:45
PERFORMANCE STUDENTS:
(Please circle)_
I give my child permission to participate in the performance at the end of the year and understand the costume fees.
I do not give my child permission to participate in the performance at the end of the year.
ZPAC COMPANY:
I give my child permission to participate in any company performances, including weddings and parties.
I do NOT give my child permission to participate in any other performances, including weddings and parties.
I would like additional information about the company.
ZPAC COMPETITION TEAM:
I give my child permission to participate in competitions and understand the fees involved.
I do NOT give my child permission to participate in the competitions
** I agree to pay the registration fee of $20.00 for the 1st child/adult, $15.00 for the 2nd child/adult of the same family, $10.00 for the 3rd child/adult of the same family and all tuition fees by the 5th of the month. For each month that my tuition is not paid by this date, I understand that a $10.00 late fee will be added to my account. If the tuition is 60 days late, your child will not be allowed in class and a 1.5% surcharge will be added on to the bill. I will sign additional contract on our payment policy. I also agree to pay $25.00 for a returned check. I also agree to pay all costume fees that apply to my account and it is understood that no refunds will be given once the costume is ordered. I also understand there is no refund for missed classes, vacations, weather, holidays, illnesses, other performances, or leaving early or arriving late to class. "Stacy Zawadzki’s Performing Arts Center (ZPAC) has my permission to use photographs of my child from class for advertising purposes."
**I have also signed the payment contract, any other contracts. I understand them fully and will abide by these contracts. Failure to abide by these contracts, I understand I may be asked to leave the center.
___________________________________ ________________________
Signature Date
** All records are kept confidential. If you have any questions, please call me!We look forward to helping create and polish our students. We strive to bring out the best in every individual. All newsletters during the year will be sent via e-mail and any other letters will be given to your child!
Sincerely,
Stacy Zawadzki-Janusz
Owner/Director/Professor