SAINT PIUS XW ARRIORS DANCE CLINIC

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					                    SAINT PIUS X WARRIORS DANCE CLINIC                                                                 SAINT PIUS X WARRIORS DANCE CLINIC
                                       FOR: Grades PK-9                                                                                   FOR: Grades PK-9
WHEN: Friday, September 7, 2012-Check-in begins at 3:30, clinic time:                              WHEN: Friday, September 7, 2012-Check-in begins at 3:30, clinic time:
4 PM-6:30 PM (parents are responsible for picking up child and taking her to                       4 PM-6:30 PM (parents are responsible for picking up child and taking her to
the game across the street)                                                                        the game across the street)
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WHERE: SPX Commons 1500 NE 42 Terrace Kansas City, MO 64116                                        WHERE: SPX Commons 1500 NE 42 Terrace Kansas City, MO 64116
WHAT TO WEAR: Comfortable work-out attire                                                          WHAT TO WEAR: Comfortable work-out attire
COST: $35 cash or check payable to St. Pius X. Cost includes entrance into                         COST: $35 cash or check payable to St. Pius X. Cost includes entrance into
game, T-shirt and two pieces of pizza. $5 discount for families ($35 for the                       game, T-shirt and two pieces of pizza. $5 discount for families ($35 for the
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1 child, $30 for the 2 or more). No Refunds will be given.                                         1 child, $30 for the 2 or more). No Refunds will be given.

Please be sure to pick your daughter up by 6:30 PM and take her to the field.                      Please be sure to pick your daughter up by 6:30 PM and take her to the field.
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The pommies will pick up the girls during the 2 quarter of the game to                             The pommies will pick up the girls during the 2 quarter of the game to
stretch. Participants will receive instruction in dance technique, jumps, kicks,                   stretch. Participants will receive instruction in dance technique, jumps, kicks,
and will learn a dance routine. All participants are invited to perform the                        and will learn a dance routine. All participants are invited to perform the
routines learned at the clinic with the St. Pius X Dance Team at the 7:00 PM                       routines learned at the clinic with the St. Pius X Dance Team at the 7:00 PM
SPX Varsity Football game on Friday, Sept. 7, 2012 @ SPX football field.                           SPX Varsity Football game on Friday, Sept. 7, 2012 @ SPX football field.
Return the form below with your payment (cash or checks to SPX) to:                                Return the form below with your payment (cash or checks to SPX) to:

Dance Team Clinic-Jill Hamerle c/o St. Pius X High School                                          Dance Team Clinic-Jill Hamerle c/o St. Pius X High School
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1500 NE 42 Terrace Kansas City, Missouri 64116 OR e-mail the                                       1500 NE 42 Terrace Kansas City, Missouri 64116 OR e-mail the
information below to jhamerle@stpiusxhs-kc.com                                                     information below to jhamerle@stpiusxhs-kc.com

REGISTRATION DEADLINE –Friday, Aug. 31, 2012 at noon! We cannot guarantee a t-shirt                REGISTRATION DEADLINE –Friday, Aug. 31, 2012 at noon! We cannot guarantee a t-shirt
if you do not register by the deadline. If shirts are not available, take $10 off the fee.         if you do not register by the deadline. If shirts are not available, take $10 off the fee.


Questions: Please call Jill Hamerle at 453-3450 ex.153, or email at jhamerle@stpiusxhs-            Questions: Please call Jill Hamerle at 453-3450 ex.153, or email at jhamerle@stpiusxhs-
kc.com or you can log on to the St. Pius X website at www.stpiusxhs-kc.com to download a           kc.com or you can log on to the St. Pius X website at www.stpiusxhs-kc.com to download a
registration form.                                                                                 registration form.


NAME: ______________________________________________________________________                       NAME: ______________________________________________________________________

School___________________________Grade__________________Age__________________                      School___________________________Grade__________________Age__________________

PARENT’S NAME: _____________________________________________________________                       PARENT’S NAME: _____________________________________________________________

PHONE (where you can be reached during the clinic):__________________________________              PHONE (where you can be reached during the clinic):__________________________________

E-Mail ______________________________________________________________________                      E-Mail ______________________________________________________________________

SHIRT (Circle size, 100% cotton): Youth: Sm        Med      Lg                                     SHIRT (Circle size, 100% cotton): Youth: Sm        Med      Lg

                                     Adult: Sm     Med      Lg                                                                          Adult: Sm     Med      Lg

By signing below, I am giving my child permission to participate in the dance clinic on Sept. 7,   By signing below, I am giving my child permission to participate in the dance clinic on Sept. 7,
2012. I understand that the SPX dance team and coach will not be held liable for any injuries      2012. I understand that the SPX dance team and coach will not be held liable for any injuries
sustained as a participant of the clinic. Please list any medical conditions:                      sustained as a participant of the clinic. Please list any medical conditions:

Parent/Guardian signature _____________________________________________________                    Parent/Guardian signature _____________________________________________________

Emergency Phone Number-& medical conditions:_____________________________________                  Emergency Phone Number-& medical conditions:_____________________________________

				
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