Spring Workshop Registration

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=82 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="0ff8dfe1esnpes.jpg"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>Bedford Dance Center</B></FONT><B>     </B><B>|</B><B>     </B><A HREF="index.htm" TARGET="_top" TITLE="Bedford Dance Center"><U><B>home</B></U></A></div> <div> <A HREF="id55.htm" TARGET="_top" TITLE="TShirt/Sweatshirt Order Form"><U>T-Shirt/Sweatshirt Order Form</U></A>   |   <A HREF="id43.htm" TARGET="_top" TITLE="Ticket Request Form"><U>Ticket Request Form</U></A>   |   <A HREF="id28.htm" TARGET="_top" TITLE="Registration Form"><U>Registration Form</U></A>   |   <A HREF="id47.htm" TARGET="_top" TITLE="Video Request Form"><U>Video Request Form</U></A>   |   <A HREF="id54.htm" TARGET="_top" TITLE="Playbill Ad Form:"><U>Playbill Ad Form:</U></A>   |   <B>Spring Workshop Registration</B></div> <div> </div> </td> </tr><tr> <td valign="top" height=398 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="0ff8dfc3.jpg"> <div> <I>Spring Workshop Registration</I></div> <bR> <div> <B>Name:</B>_______________________________________________________________<B>DOB:</B>_________________</div> <bR> <div> <B>Address</B>:___________________________________________________________________________________</div> <bR> <div> <B>Phone:</B>_______________________ <B> Cell:</B>_______________________ <B>E-Mail:</B>___________________________</div> <bR> <div> <B>Previous Training:</B>___________________________________________________________________________</div> <bR> <div> ___________________________________________________________________________________________</div> <bR> <div> ___________________________________________________________________________________________</div> <bR> <bR> <div> <B><U>Spring Workshop Registering For</U></B><B>:</B></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="720" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="32"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="32" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="242"><div> <B>WORKSHOP NAME</B></div> </tD> <tD VALIGN=TOP WIDTH="174"><div> <B>DAY / TIME</B></div> </tD> <tD VALIGN=TOP WIDTH="165"><div> <B>DATES</B></div> </tD> <tD VALIGN=TOP><NOBR><div> <B>TUITION</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 18 WIDTH="32"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="18" ALIGN="bottom" WIDTH="32" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="242"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="18" ALIGN="bottom" WIDTH="242" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="174"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="18" ALIGN="bottom" WIDTH="174" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="165"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="18" ALIGN="bottom" WIDTH="165" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="67"><div>  </div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="32"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="32" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="242"><div> <B>The Stretch Workshop</B></div> </tD> <tD VALIGN=TOP><NOBR><div> Saturdays, 9:30-10:30</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="165"><div> May 3, 10, 17 & 31</div> </tD> <tD VALIGN=TOP WIDTH="67"><div> $40.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="32"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="32" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP><NOBR><div> <B>Ballroom Session 2:  Salsa</B></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="174"><div> Fridays, 6:30-7:30</div> </tD> <tD VALIGN=TOP WIDTH="165"><div> May 2, 9, 16, & 30</div> </tD> <tD VALIGN=TOP WIDTH="67"><div> $40.00</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="32"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="32" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP><NOBR><div> <B>Musical Theater Master Class</B></div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> Saturday, 10:00-3:00</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="165"><div> May 3</div> </tD> <tD VALIGN=TOP WIDTH="67"><div> $50.00</div> </tD> </tR> </TABLE></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>~  Single Class Rate:  $11.00 ~</B></div> <bR> <div> <B><U>RELEASE</U></B><B>: </B></div> <bR> <div> It shall be the responsibility of each student, participant, observer, or any other person upon the premises owned, used, or leased by the Bedford Dance Center to adhere to the policies and guidelines set forth by this studio.  Neither the Bedford Dance Center, Karen Pariseau, individually or any other instructor or agent of the Bedford Dance Center shall be liable for any loss or damage to property or bodily injury or death of persons occurring in an activity of the Bedford Dance Center, or related thereto.  All damages arising from injuries suffered during activities of the Bedford Dance Center shall be the sole responsibility of each student, a student's parent(s) or a student's guardian(s), whether or not caused or not caused by the negligence or fault of the Bedford Dance Center, Karen Pariseau, or any other agent of the Bedford Dance Center.  I/We understand that images and/or likenesses may be used for advertising or promotional materials.</div> <bR> <div> Parent/Guardian Signature:____________________________________________________     Date:___________</div> <bR> </td> </tr></table></body>