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The Maine Dance Academy Registration Form & Dance Camp Schedule 
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Dancer’s Name:____________________________________________________________ Age @ date of camp: ______________________
Parent’s Name: ___________________________________________________ Phone #:_________________Cell #:___________________
Address:__________________________________________________ e-mail address:__________________________________________
T-shirt Size: Child small Child medium Child large Adult small Adult medium Adult large Adult x-large
WARNING OF RISK TO PARTICIPANT
The Maine Dance Academy (TMDA) is not responsible for providing medical accidental injury insurance on students. Parents/guardians are required to provide adequate accidental and medical insurance for their child enrolled in TMDA. My child and I are aware that participation in all TMDA dance classes is potentially hazardous and may involve risk of injury. TMDA, Colleen DuPlissie, the teachers, the assistants, the secretaries and the owner of the property at 15 Sweden Street, Caribou, ME shall not be held responsible for treatment, injury or losses related to TMDA. Neither Colleen DuPlissie, nor any teacher, nor the studio, nor the owners of said property are liable for the loss or damage to personal property. As a parent, guardian, and/or participant, I am aware of the hazards and my ability or my child’s ability to participate. Each student may decline to participate in any activity but only with written permission of a parent or guardian. Please inform the teachers of any physical limitations or conditions. I hereby, for myself, my heirs, executors and administrative waive and release all rights and claims against The Maine Dance Academy, it’s employees, volunteers and owners from all losses, injury, damages, fees and other expenses arising out of, or in connection with all our participation at The Maine Dance Academy. I have also read the entire rules and regulations posted on TMDA’s website and will adhere to them accordingly.
Parental Signature____________________________________________________________________________________________________________________________Date:_________________________________
Please fill in the requested information above and return it by July 1, 2016 with your Non-refundable dance camp fee to: The Maine Dance Academy, c/o Colleen DuPlissie, 19 Coolidge Avenue, Caribou, ME 04736. You will only be considered registered for TMDA dance camp when a completed form and dance camp fee is received by TMDA.
Cost for Summer Dance Camp 2016: 3-8 year olds will be $130.00, 9+ will be $150.00 which includes free camp t-shirt! Classes will be held at our Sweden Street Studio. Beginners are welcome as dance camp is designed for lots of fun!!
Colleen DuPlissie: Owner of TMDA. Miss Colleen will be teaching Jazz, Theatrical and Contemporary.
Clarann Floyd: TMDA instructor for 15 years. Miss Clarann will be teaching Celtic Technique for ages 6 and above and jazz/hip hop for younger ages.
Danielle Atcheson-Peterson: TMDA graduate in 2005 and has 24 years of dance and tumbling experience. Miss Danielle will be doing dance art with our younger dancers.
Meredith Sleeper, Kaitlin Kinsey, Emma Jandreau & Delaney Williams: All are TMDA graduates, all played the leads in our recitals as seniors (Mere as Mary Poppins, Kaitlin as Dorothy, Emma as Princess Anna and Delaney as Shrek) and all will return to guest instruct. All have furthered their dance education at their respective colleges or universities. They will be teaching in the areas of hip-hop, contemporary and lyrical dance.
Dance Schedule for Summer Dance Camp: July 18-22, 2016
2-2:45pm 3-5 year olds 6-8 year olds
3-3:45pm 9-12 year olds 3-5 year olds 6-8 year olds
4-4:45pm 6-8 year olds 9-12 year olds 3-5 year olds
5-5:45pm 13+ 9-12 year olds
6-6:45pm 9-12 year olds 13+
7-7:45pm 13+
8-8:45pm 13+
1- Dancers should be dressed for dance….shorts and tanks are best. If you have dance shoes/sneakers then please wear those. 9-12 and 13+ should bring their taps if they have them. The dance store will be open the first day of camp if anyone should need supplies.
2- Parents should not drop off students for the entire day if they that cannot go to the bathrooms by themselves. We ask that parents wait in the waiting area if their children will need help in between classes. The 15 minute break is designed for the instructors as well as the students. There will be no supervision provided in between classes.
3- Students should have plenty of liquids and snacks in between classes. TMDA does have a soda/juice/water machine in the waiting area.
4- T-shirts will be handed out on Thursday for all students to wear on the final day of classes on Friday.
5- TMDA reserves the right to combine classes if necessary. TMDA will cap off all classes to 20, so please register early. You will receive confirmation as soon as TMDA receives your registration and fee.
6- We absolutely need an email as this is how we will communicate with you throughout the summer. We will email you the final class roster and the updated summer dance schedule on July 11, 2016.
7- Friday classes will all be a half hour long with Parent-Watch the last 10 minutes of each class, therefore 3-5 year olds will have classes from 2-3:30pm, 6-8 year olds 2-3:30pm, 9-12 year olds 3:30-5:30pm and 13+ will have classes from 5-7pm.
8- Students may have different teachers each day therefore, older children should make sure they have their paws, sneakers and taps with them at all times.
9- If you have any questions, please feel free to contact me at *****@***com . We look forward to working with your children!


