THE MAINE DANCE ACADEMY
2009-2010 Dance Registration
TO BE USED FOR All STUDENTS REGISTERING AT  TMDA for 2009-2010
Dancer Name:
Address: (street/City)
Home Phone (use hyphens)
Work/Cell Phone
Date of Birth:
Age:
Grade entering 2008 school year:
Dance Class participated last year:
Parent's Name:
Email Address: (very important)
Take Pointe Class last year?
Yes
 No
If "Yes", which class?
Would you like to take Pointe this year?
Yes
 No
Note:  All pointe dancers are required to purchase 2 pairs of pointe shoes for the
year, one for studio practice and one set to stay clean for recital performances.
Shoe Size:
Shirt Size:
Pant Size:
C-M
C-S
 C-L
Dance T- Shirt Size: (check one)
A-S
 A-M
A-L
A-XL
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.  You indicate your agreement by
entering your name below.  All losses suffered while dancing at TMDA are the sole responsibility of
the client entering his/her name below and you wil not hold TMDA liable for anything.
Type Parent Name:
I am also aware that at various points during the dance year, TMDA will be sharing pictures of their dancers on their website .I
recognize that TMDA may post pictures (not names) of myself and/or my child on their website. I hereby consent for myself
and/or my children to have their pictures put on the website at www.themainedanceacademy.com.
Type Parent Name:
BEFORE, you press register, take a quick minute to review everything you have entered into the form
above.  Please be sure it is accurate, names spelled appropriately, and all info is complete!
REMINDER:  Please send a check for the $30.00/$35.00 registration fee to 82 Solar Drive, Caribou, Me 04736.  
Thank you!
To simply the process of registration, we have decided to automate registration through the website.  If you are a new student over the age of 5, you must fill out
this registration form and mail in your check to the address below and you must also attend auditions at the  studio on August 19, 2009. If you are a returning
TMDA student, simply fill out this form, press submit and then send a check for $30 to the address below.   Completing this form is easy, just enter your dancer's
information in the spaces provided.  When you are finished, click the submit button at the bottom. Yo will receive a confirmation notice from Miss Colleen stating she
has received your registration through e-mail. At this time we are unable for you to pay the registration fee through the website, so you are still required to send a
check for $30 for returning student registration fee and $35 for all new student registrations to 82 Solar Drive, Caribou, ME 04736.  We are hoping that using the
site will reduce the number of late registrants and help us prepare for the year more efficiently. Registering before 8-19-2009 ensures your spot with TMDA!  
Registrations fees RECEIVED after 8-19-2009 are all $50.00 with no exceptions and no guarantee of a spot at TMDA!!
The Maine Dance Academy Registration and Audition
Schedule for August 19,2009.

3-4pm: 2-4 year olds, registration only
4-5pm:  5-7 year olds, registration and auditions are required.
5-6pm:  8-10 year olds, registration and auditions required
6-7pm:  11-13 year olds, registration and auditions required
7-8pm: 14 and up, registration and auditions required.

Only new students 5 and older are required to audition.  
Returning High School students do not need to audition.  

Registration Fee for Returning TMDA students is
$30.00

Registration Fee for New Students is
$35.00

All registrations are due on or before August 19,2009. All late
registrations will be $50.00.  The late fee will be added to
your fall tuition bill.