Almost Famous Winter Recital Special Sessions - Almost Famous

							                                                      Almost Famous
                                    Winter Recital Special Sessions
 Light Routine: (K-12th Graders) Learn a fun light stick routine to perform at the Almost Famous Winter Recital
       on Sunday, December 16th. Cost is $25.00 including Light Sticks. For Recital please wear all black.

                              Monticello Clinic Dates: December 6th and 13th from 5:00 – 5:45 p.m.
                                Farley Clinic Dates: December 4th and 11th from 5:15-6:00 p.m.

Dad & Daughter Dance: (k-12th Graders) Learn a fun routine and dance with your dad at the Almost Famous
Winter Recital on Sunday, December 16th. Cost is $35.00 including a t-shirt for dad and dancer. At recital dad
            will wear jeans and tennis shoes; and dancer will wear black shorts with dance shoes.

                               Monticello Clinic Dates: December 2nd and 9th from 5:15-6:00 p.m.
                                Farley Clinic Dates December 5th and 12th from 5:30-6:15 p.m.

        Please cut bottom of sheet an attach with payment. Registration deadline is November 20 th 2012.
        Please turn in waiver and money at studio or mail payment to:
        Almost Famous 231 S Cedar Street Monticello, Ia 52310

_________________________________________________________________________________________

Student Name:_________________________________ Student Grade:_________

Parent/Guardian Name:__________________________ Phone Number:_____________

Home Mailing Address:_____________________________________________________

Email Address:____________________________________________________________

Dancer T-shirt Size: YS        YM   YL   YXL     AS   AM     AL AXL

Dad T-shirt Size: AS       AM       AL         AXL    A2XL    A3XL

Emergency Contact Name & Number:_________________________________________

My child___________________________ has permission to participate in classes at Almost Famous Inc. I release Almost
Famous Inc. and its staff members from any and all responsibilities and liabilities due to an injury or accident occurring
during participation in activities provided by Almost Famous Inc. I am aware that an emergency may occur because of
the physical activity that is involved with the program. In the event of an emergency I give permission to Almost Famous
Inc. and its staff to attain and sign for medical treatments. I have read the above statement.

Signature of Parent or Legal Guardian:

X_________________________________________________Date:________________