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The LaVilla School of the Arts - Duval County Public Schools

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<strong>The</strong> <strong>LaVilla</strong> <strong>School</strong> <strong>of</strong> <strong>the</strong> <strong>Arts</strong>’<br />

Dance<br />

Department<br />

Director: Michelle Ottley-Fisher<br />

Co-Chair: Susan Jennings<br />

501 North Davis Street<br />

Jacksonville, Florida 32202<br />

(904) 633-6069 ext. 179 or 127<br />

Dance booster website www.lasotadance.com<br />

Welcome Dancers and Parents,<br />

to <strong>the</strong> <strong>LaVilla</strong> <strong>School</strong> <strong>of</strong> <strong>the</strong> <strong>Arts</strong>’ Dance Department. <strong>The</strong> information in<br />

this packet is designed to answer most, if not all, <strong>of</strong> your questions about our<br />

program. We’ll also be using it to ga<strong>the</strong>r information about you. To this end we<br />

ask that you be sure to read through this packet very carefully and return <strong>the</strong><br />

necessary forms in this packet by <strong>the</strong> dates indicated. If, however, you still have<br />

any questions or concerns, call us at 633-6069 ext 118 or ext 127. Don’t be<br />

discouraged by <strong>the</strong> answering machine. Most <strong>of</strong>ten it’s our only indication that<br />

you’ve called. Once again, welcome and let’s look forward to an incredible new year.


Our Mission:<br />

<strong>The</strong> dance department at <strong>the</strong> <strong>LaVilla</strong> <strong>School</strong> <strong>of</strong> <strong>the</strong> <strong>Arts</strong> strives<br />

towards <strong>the</strong> same end for all <strong>of</strong> our dancers; to expose all dancers to and<br />

educate <strong>the</strong>m in a variety <strong>of</strong> technical dance styles, primarily ballet, but also<br />

to include jazz and modern dance techniques; to enhance <strong>the</strong>ir basic tactile<br />

development with fur<strong>the</strong>r training in tap, hip-hop, choreography and dance<br />

history and current knowledge; and finally, to encourage a more aes<strong>the</strong>tic<br />

awareness <strong>of</strong> dance through such necessary extras as guest artists, field trips,<br />

workshops, and performance opportunities.<br />

To ensure that all dancers enjoy <strong>the</strong> maximum benefit from this program<br />

dancers are placed into classes based on technical level and not be age or<br />

grade. Achievement to <strong>the</strong> next level, <strong>the</strong>n, comes after strong technical<br />

advancement and increased discipline and not necessarily because <strong>of</strong> grade<br />

level advancement.<br />

Our philosophy <strong>of</strong> learning revolves around enhancing and structuring <strong>the</strong><br />

dancer’s training to lead towards a true appreciation, if not a continued<br />

study, <strong>of</strong> dance. Rest assured <strong>the</strong>n that everything that we ask <strong>of</strong> your<br />

dancer is towards this goal. We hope that you would expect no less <strong>of</strong> us.<br />

We also hope to develop a trusting, positive and nurturing environment for<br />

all involved. In short… have a great time!<br />

Thank You,<br />

<strong>The</strong> <strong>LaVilla</strong> <strong>School</strong> <strong>of</strong> <strong>the</strong> <strong>Arts</strong> Dance Faculty


<strong>The</strong> <strong>LaVilla</strong> Dance Department Dress Code<br />

*** (PLEASE LABEL ALL SUPPLIES WITH DANCER’S LAST NAME AND FIRST INITIAL)<br />

See information for ladies on <strong>the</strong> left and information for gentlemen on <strong>the</strong> right<br />

Ladies: ______________________________Gentlemen:<br />

Ballet<br />

o 2 Black Leotards (any sleeve style) 2 Solid White T-shirts<br />

o 2 Pairs <strong>of</strong> Pink Tights 2 Pairs <strong>of</strong> Black Tights<br />

o Pink Ballet Slippers Black Ballet Shoes<br />

Plus...<br />

**Tights may be full footed or convertible. ** Men‟s tights must have a black center<br />

** Dance Levels 5-8 will need pointe shoes **Dance Levels 7-8 also need White<br />

** Dance Levels 7-8 also need seamed pink tights Tights and White Ballet Shoes<br />

Hair must be in a bun for ballet classes ( See HairNotes on <strong>the</strong> next page)<br />

Jazz<br />

o Solid Color Leotard Solid Color T-Shirt<br />

o Tan Tights Black Dance Pants<br />

o Tan Jazz Shoes Black Jazz Shoes<br />

Hair must be <strong>of</strong>f face, neck and ears for jazz and modern classes ( See HairNotes on <strong>the</strong> next page)<br />

Plus...<br />

**Any Slip-on or Lace up style shoes acceptable SEE INFORMATION TO THE LEFT<br />

** No sneakers for class, please. You’ll have a sneaker opportunity with Hip-Hop workshops<br />

**Tights must be convertible<br />

Modern<br />

o Black Leotard Black T-shirt<br />

o Black Footless Tights Black Dance Pants<br />

Plus...<br />

Ladies Must Also Have Gentlemen Must Also Have<br />

o A small dance bag A small Dance Bag<br />

o A black or flesh colored sports bra A flesh-toned dance belt<br />

o A flesh-toned camisole A 2” black headband if nec.<br />

o A supply <strong>of</strong> hair ties and pins<br />

o A 2” thick black headband if short hair<br />

Undergarments may not be worn beneath dance attire.<br />

Ladies we’ll talk about options to undies<br />

Please wait until fur<strong>the</strong>r notice before purchasing Tap shoes or Pointe shoes<br />

for levels o<strong>the</strong>r than <strong>the</strong> ones indicated. At that time Tap shoes will have to be tan<br />

for <strong>the</strong> ladies and black for <strong>the</strong> gentlemen. <strong>The</strong> dance department allows cover-


ups during <strong>the</strong> Winter Season for <strong>the</strong> warm-up portion <strong>of</strong> class. Acceptable covers<br />

are ballet skirts, dance pants, dance sweaters, sweat pants and leg-warmers.<br />

<strong>LaVilla</strong> Dance Supply and Wish List<br />

<strong>The</strong>se items are products to aid <strong>the</strong> dancer in being successful in <strong>the</strong> academic portion<br />

<strong>of</strong> <strong>the</strong>ir dance experience here at <strong>LaVilla</strong>. Some o<strong>the</strong>rs are to help us all remain<br />

healthy and organized, which will also help us to be successful.<br />

All dancers will need to have:<br />

� A school issued planner (<strong>The</strong> planner will be used daily and should be checked<br />

every Friday for handouts, calendars, returned work and grading information.)<br />

� A 1 inch White 3 ring binder with pockets<br />

o <strong>The</strong> binder needs to have <strong>the</strong> clear windows on <strong>the</strong> outside as well as<br />

pockets<br />

� One folder with pockets and binder holes<br />

� A pocket ballet dictionary<br />

� A book for reading (anything dance; fiction or non-fiction, hard or s<strong>of</strong>t back)<br />

� A pencil bag with binder holes<br />

� 1 package <strong>of</strong> pencils<br />

� 1 package <strong>of</strong> pens<br />

� <strong>The</strong> special extra indicated below based on your class level indicated on<br />

your schedule.<br />

Dance 1 & 2: Multicolor Construction paper and/or Band Aids<br />

Dance 3 & 4: One pack <strong>of</strong> copy paper (white or color) and/or Loose Leaf Paper<br />

Dance 5 & 6: 2 packages <strong>of</strong> #2 pencils and/or Band Aids<br />

Dance 7 & 8: A small supply <strong>of</strong> blank CDR-Music and/or DVD discs<br />

You Can Also Help Us Greatly With <strong>The</strong> Following Supplies<br />

� 1 large container <strong>of</strong> disinfecting wipes<br />

� 1 bottle <strong>of</strong> hand sanitizer<br />

� 2 Glade Plug-In Scented Oil<br />

� 2 boxes <strong>of</strong> facial tissues<br />

� 1 small container <strong>of</strong> liquid laundry detergent<br />

� 1 package <strong>of</strong> paper towels<br />

� 1 mesh laundry sack or plastic storage container (any size)<br />

� 2 boxes <strong>of</strong> bandages<br />

� 1 tube <strong>of</strong> Benedryl/anti-allergy ointment ( no donation needed at this time)<br />

� 1 re-freezable ice pack<br />

Thank you for considering our wishes


HAIRNOTES<br />

For all dance classes, <strong>the</strong> dancer’s hair must be secured <strong>of</strong> <strong>the</strong> face, neck and<br />

ears. For <strong>the</strong> ballet class it is required that <strong>the</strong> female dancer wear <strong>the</strong> hair in a<br />

clean, secure bun.<br />

o <strong>The</strong> bun must be wrapped, pinned and gelled, if necessary to eliminate<br />

wisps, bangs, falls, or curls about <strong>the</strong> face and neck.<br />

o If <strong>the</strong> dancer‟s hair is comparatively short and cannot be pulled back<br />

into a tie or elastic, it is <strong>the</strong>n required that <strong>the</strong> hair be held by a 2” thick<br />

black headband. This rule applies to both ladies and gentlemen.<br />

(Gentlemen are not required to wear a bun; however, measures must be taken to<br />

create a clean, secure style).<br />

o For all o<strong>the</strong>r classes, <strong>the</strong> hair may be worn in a clean ponytail without<br />

distractions, but a bun is always more preferred.<br />

<strong>The</strong> <strong>LaVilla</strong> dance department will accept braid styles that strictly meet with<br />

<strong>the</strong> following guidelines. Please be sure to follow <strong>the</strong>m closely to avoid grade<br />

reduction.<br />

o Braids must be no larger than a medium size (no thicker than a<br />

kindergarten pencil)<br />

o Braids must be a length that can be easily pulled up into a bun. (We<br />

suggest no longer than shoulder blade.)<br />

o Cornrows, Twist, or Shreds, Curly Braids, even Afro puffs are allowed.<br />

o Braids must be maneuverable enough to secure in a neat “chignon” style<br />

bun <strong>of</strong>f <strong>the</strong> face, neck and ears.<br />

o <strong>The</strong>re should be no portion <strong>of</strong> <strong>the</strong> braid style that cannot be secured in<br />

<strong>the</strong> bun<br />

*In support <strong>of</strong> maintaining a healthy hair style, please ask stylists not to pull<br />

braids too tightly at <strong>the</strong> starting points<br />

Be sure that hair adornments are not distracting, hindering to movement or a<br />

potential hazard.


Ballet Shop<br />

799 Blanding Blvd. (Orange Park)<br />

(904)276-5992<br />

Dance „n‟ Stuff Boutique<br />

8011-3 Merrill Road (Arlington)<br />

743-6080<br />

1368 Beach Blvd (Beaches<br />

(904)247-8006<br />

Danskin Outlet<br />

5080 International Drive<br />

Orlando, Florida 32819<br />

(407) 351-2364<br />

Julian‟s dancewear<br />

9825 San Jose’ Blvd #31<br />

(904) 880-0111 (San Marco/Mandarin)<br />

Make Believe Costumes & Dancewear<br />

1855 Parental Home Road (Southside)<br />

645-6337<br />

10950 San Jose’ Blvd. (Mandarin)<br />

880-2288<br />

Ultimate Dancewear & Accessories<br />

9560 Lem Turner Road (Northside)<br />

(904) 766-0009<br />

Willie‟s For Kids<br />

3567 St. John’s Avenue<br />

(904) 384- 3664 (Avondale)<br />

Inexpensive Online options<br />

Local Dancewear Establishments<br />

www.onlinedancewear.com www.justforkix.com<br />

www.discountdancesupply.com www.dancewearsolutions.com


www.allaboutdance.com<br />

Also try your local Target, Wal-Mart, or Payless<br />

Grading Policies<br />

<strong>The</strong> dancer’s grade is dependant on three major factors: 1) his/her daily participation/<br />

success with performance guidelines & 2) his/her individual advancement in dance<br />

technique and performance and 3) his/her quarterly success with written work and<br />

standards achievements.<br />

1) <strong>The</strong> Participation Grade will include points accrued each day for<br />

o Timeliness to <strong>the</strong> studio from <strong>the</strong> dressing rooms<br />

o Proper attire based on <strong>the</strong> technique being taught<br />

o Proper shoes based on technique being taught<br />

o Proper hair based on technique being taught<br />

o Overall classroom participation and technical development<br />

Since this is a performance art, <strong>the</strong> participation grade will also reflect <strong>the</strong> dancer’s displayed level <strong>of</strong><br />

intent, focus, discipline, respect and <strong>the</strong> dancer’s self-motivation and commitment to advance.<br />

Although fairly subjective, this is a very specific area <strong>of</strong> assessment. This section <strong>of</strong> <strong>the</strong> participation<br />

grade is an average <strong>of</strong> each regular dance instructor that that dancer meets with.<br />

**IMPORTANT<br />

When you just can‟t dance<br />

o Please return a parent/guardian written and signed note when <strong>the</strong> dancer is too ill<br />

or injured to dance.<br />

o After three days, <strong>the</strong> excuse note must be physician-issued.<br />

o Dancer’s will be asked to complete make-up classes after three absences or nondressed<br />

days (excused or unexcused)<br />

o Dancer’s will be required to complete a written make-up assignment if injury or<br />

illness extends past 7 days and must be able to pass <strong>the</strong> quarter final according to<br />

county rules.<br />

o Unexcused non-dressed days will result in a loss <strong>of</strong> half- <strong>of</strong> <strong>the</strong> daily points when a<br />

written assignment is completed correctly and returned with a parent’s signature.<br />

o 5 unexcused non-dress days will result in an automatic failing grade<br />

2) <strong>The</strong> Dance Advancement Grade is dependant on <strong>the</strong> student’s individual work<br />

ethic and advancement. This grade will be an average <strong>of</strong> Teacher assessments<br />

from each instructor that <strong>the</strong> dancer sees.<br />

3) <strong>The</strong> Written Grade will assess points earned from vocabulary worksheets,<br />

quizzes, tests, “Dance News Assignments” (DNA’S) and final exams. DNA’s are<br />

week long, research assignments based on a specific area <strong>of</strong> dance development.<br />

<strong>The</strong> final exams may be written, practicum (movement) or oral.


**Please understand that it is important to <strong>the</strong> growth <strong>of</strong> a dancer to know <strong>the</strong> history, current events<br />

and information that affects a dancer. It is also imperative to be able to express oneself in writing.<br />

We‟ve chosen this standard to support your academic standing.<br />

<strong>The</strong> Dance Enrichment Fee<br />

(DEF)<br />

<strong>The</strong> Dance Enrichment Fee is a yearly fund that is donated by <strong>the</strong> dancers and<br />

<strong>the</strong>ir parents to help cover expenses incurred by <strong>the</strong> dance department. <strong>The</strong>se<br />

expenses include guest artist classes, choreographer fees, workshop fees, costuming,<br />

field trips, transportation, performance security, make-up class instruction, and even<br />

some equipment, travel, s<strong>of</strong>tware and supplies<br />

<strong>The</strong>se extras do so much to enhance <strong>the</strong> quality <strong>of</strong> learning that we’ve come to<br />

expect <strong>the</strong>m and <strong>the</strong>y are invaluable in <strong>the</strong>ir capacity. <strong>The</strong>y do come with a hefty<br />

tag. To costume an average class <strong>of</strong> 25 dancers it could <strong>the</strong>oretically cost $1,300.<br />

We have 8 levels <strong>of</strong> classes. Just one guest can run $ 100 a workshop/class. If<br />

choreography is involved, an added $500-$800 is required just for <strong>the</strong> rights to <strong>the</strong><br />

choreography. <strong>The</strong>n <strong>the</strong>re is usually rehearsal time, and travel/room/board.<br />

So you see, and I’m sure many <strong>of</strong> your already know, dance is an expensive art<br />

form. Your DEF is just about all we have. We will also be <strong>of</strong>fering fundraisers<br />

through <strong>the</strong> dance booster organization and <strong>the</strong> dance department. Some<br />

fundraisers will go to <strong>the</strong> general fund, and o<strong>the</strong>rs to <strong>the</strong> dancer’s individual<br />

account for class-specific events.<br />

o <strong>The</strong> DEF can be paid all at once or in installments at Orientation, <strong>the</strong><br />

Meet & Greet, Open House or at <strong>the</strong> September, October and<br />

November Booster Meetings.<br />

o <strong>The</strong> DEF should be covered in its entirety by <strong>the</strong> November Booster<br />

Meeting<br />

o A separate handout <strong>of</strong> <strong>the</strong> Enrichment Fee will be supplied<br />

Dance Levels 1 & 2 (first period)- $50<br />

Dance Levels 3 & 4 (second period) -$75<br />

Dance Levels 5 & 6 (third period) -$125<br />

Dance Levels 7 & 8 (fourth period) -$150<br />

If we are unable to receive your dancer‟s DEF payment<br />

o Your dancer will not earn a costume for any dance department concert<br />

o Your dancer will not be able to participate in payment based<br />

workshops/field trips or activities


o Your dancer will not be able to collect his/her yearbook<br />

O<strong>the</strong>r Important Information<br />

Performing:<br />

All dancers in <strong>the</strong> department are invited to perform in <strong>the</strong> Spring Dance<br />

Concert which closes out our dance year with a bang! We also will be hosting,<br />

new this year, a Fall Concert Showing, Building Dances Showing and <strong>the</strong> annual<br />

Guest Artist Concert. Details on <strong>the</strong>se three concerts will be discussed later.<br />

<strong>The</strong>re are also o<strong>the</strong>r open or class-level workshop or performance opportunities.<br />

<strong>The</strong> dancer’s will be made aware <strong>of</strong> this information ahead <strong>of</strong> time. <strong>The</strong> dancer<br />

must maintain a GPA <strong>of</strong> 2.0 for <strong>the</strong> quarter in order to perform, but is not<br />

penalized fur<strong>the</strong>r if <strong>the</strong>y are restricted. In most cases <strong>the</strong> dancer will be allowed<br />

<strong>the</strong> opportunity to participate in <strong>the</strong> concert in ano<strong>the</strong>r capacity and receive<br />

performance extra credit along with his/her peers.<br />

All dance concert begin at 7:30pm and will have a call time <strong>of</strong> 6:00pm.<br />

<strong>The</strong> Tap Ensemble:<br />

This is an after-school performance ensemble made up <strong>of</strong> students from any<br />

arts area who are pr<strong>of</strong>icient if tap dancing and performance. This ensemble will<br />

meet weekly to learn choreography and in a variety <strong>of</strong> tap styles. <strong>The</strong> student will<br />

need to audition for <strong>the</strong> ensemble and will be required to sign a contract for<br />

participation. This is not a tap class. <strong>The</strong> dancers will be <strong>of</strong>fered tap technique<br />

classes beginning at Dance Level 3.<br />

Menzklub<br />

This after school group is open to all dancers and is a mandatory class for all<br />

<strong>the</strong> gentlemen in <strong>the</strong> dance department. Here, <strong>the</strong> gentlemen focus on male<br />

dance development, partnering techniques, and strength training not tackled<br />

in <strong>the</strong> regular dance class. It is averaged into <strong>the</strong> class grade and is imperative<br />

to <strong>the</strong> proper movement-growth <strong>of</strong> <strong>the</strong> male dancer.<br />

Dance Ensemble 7 and <strong>the</strong> Dance Repertoire Ensemble (Level 8)<br />

<strong>The</strong> dancers in block 4 have auditioned for placement at this level and have<br />

displayed pr<strong>of</strong>iciency in ballet, pointe, modern and jazz dance techniques. All<br />

dancers in this level must also maintain a 2.0 overall GPA and a 3.5 Dance GPA.<br />

<strong>The</strong> Dance Repertoire Ensemble are those selected for Dance Level 8. <strong>The</strong>y serve<br />

as ambassadors to <strong>the</strong> department and meet weekly for mandatory repertoire<br />

work and rehearsals.


<strong>The</strong> Dance Department Booster Volunteer Form Part 1<br />

<strong>The</strong> Dance Booster Organization is an association <strong>of</strong> parents, businesses and o<strong>the</strong>r<br />

friends <strong>of</strong> <strong>the</strong> <strong>LaVilla</strong> Dance Department whose primary focus is to assist in <strong>the</strong><br />

many ways that improve <strong>the</strong> quality <strong>of</strong> <strong>the</strong> <strong>LaVilla</strong> dance experience. <strong>The</strong> Club<br />

follows booster and school organizational guidelines. <strong>The</strong>re are so many ways to<br />

get involved with your dancer’s time here at <strong>LaVilla</strong> and we can think <strong>of</strong> many<br />

more. Please consider a commitment <strong>of</strong> 2 hours a month and volunteering in at<br />

least one dance event this year. If we can get that from just one parent per dancer<br />

we could accumulate approximately 400 “man-hours” and invaluable memories.<br />

Speaking <strong>of</strong> commitment, take a look at what we have below and don’t forget to fill<br />

out <strong>the</strong> district volunteer form<br />

Active Booster Membership Commitment Statement<br />

If you’re really ready to jump into <strong>the</strong> dance year here at <strong>LaVilla</strong>? <strong>The</strong>n put on<br />

those running shoes and let’s hit <strong>the</strong> ground! <strong>The</strong> dance booster organization<br />

really needs you and most importantly we need your time, expertise and services.<br />

Below you’ll find a listing <strong>of</strong> <strong>the</strong> many activities and events that we try to <strong>of</strong>fer<br />

<strong>the</strong> dancers, but so many <strong>of</strong> <strong>the</strong> events are not even possible without your helping<br />

hand. So, we’re not only asking that you consider volunteering, but that you make<br />

a specific decision to help and where you’d like to help. To help you make your mind<br />

up quickly we’d like to <strong>of</strong>fer you a little incentive.<br />

1) Each household will receive a $5 commitment waiver <strong>of</strong>f <strong>the</strong> DEF simply for<br />

volunteering and committing your time and or expertise to a dance booster<br />

activity.<br />

2) <strong>The</strong>n, if your enrichment fee is covered by or before September 30th, your<br />

dancer can receive a $10 credit towards ei<strong>the</strong>r <strong>the</strong> Manhattan Dance Project<br />

(October 9 th & 10 th ) or <strong>the</strong> Florida Dance On Tour (October 29 th -31 st ). Just let us<br />

know which.<br />

3) Dancers with siblings in currently in <strong>the</strong> department may also earn a 10%<br />

discount.<br />

So, c’mon make <strong>the</strong> commitment to make dance awesome for your dancer while<br />

<strong>the</strong>y’re at <strong>LaVilla</strong>. Ei<strong>the</strong>r way; you win and so does your child!


<strong>The</strong> Dance Department Volunteer Form Part II<br />

Please Fill out and Return by Sept 12th<br />

Level______ Grade______<br />

Dancer’s Name______________________________________________________<br />

Volunteer’s Name (s) __________________________________________________<br />

Contact Information: Daytime Phone ___________________<br />

Evening Phone___________________<br />

Cell/Pager Number________________<br />

Email Address (es) _________________________________<br />

I __________________ would like to <strong>of</strong>fer my time and/or services to my dancer<br />

by way <strong>of</strong> <strong>the</strong> positions, events, or activities indicated below and gladly reap <strong>the</strong><br />

dual benefits.<br />

Volunteer Areas <strong>of</strong> Interest:<br />

_____Annual Trip _____Concessions _____ Fundraising<br />

_____ Chaperoning _____Grant Writing/Business Partnerships<br />

_____ Phone Message/ Newsletter/Manager _____Merchandise<br />

_____ Costume Room _____ <strong>The</strong> Turkey Tick _____ Concerts<br />

_____ Events/Workshops _____ Historian<br />

_____ Office Manager _____Event Videographer/ Archiving


Thank you so much for your time and information. We<br />

will use all <strong>of</strong> it responsibly!<br />

Have a great year!<br />

<strong>The</strong> Dance Information Form<br />

Please Fill out and Return by Sept 12th<br />

Dance Level _______ Grade ________<br />

Dancer‟s Name _______________________________________________________<br />

Address _____________________________________________________________<br />

____________________________________________________________________<br />

Current Grade __________ Age __________ Date <strong>of</strong> Birth __________________<br />

Home Phone # _______________ Cell Phone # ________________<br />

Dancer‟s email address ________________________________________________<br />

Parent/ Guardian 1____________________________________________________<br />

Address______________________________________________________________<br />

_____________________________________________________________________<br />

Home Phone # __________ Work Phone # ___________Cell Phone # __________<br />

Parent/Guardian email addresses__________________________________________<br />

Parent/Guardian 2 _____________________________________________________<br />

Address ______________________________________________________________<br />

_____________________________________________________________________<br />

Home Phone # __________ Work Phone # ____________ Cell Phone # _________<br />

Dancer‟s Training Background ___________________________________________<br />

_____________________________________________________________________<br />

_____________________________________________________________________


_____________________________________________________________________<br />

Dance Enrichment Fee Payment Record<br />

Please fill out and return by Sept 12th<br />

Dancer’s Name _________________________ Dance Block________ Grade_____<br />

Enrichment Fee Amount $ ____________<br />

Parent/Guardian Name(s) ______________________________________________<br />

(please print)<br />

_________ Paid in one lump sum at Orientation, <strong>the</strong> Meet & Greet, Open House,<br />

September Booster, and October Booster, November Booster<br />

_________ Paid in Installments<br />

____________________, ______________________, and _____________________<br />

Sibling Name ___________________________ <strong>Arts</strong> Area _____________________<br />

**Please do not send cash in with your dancer.<br />

Signature <strong>of</strong> Parent/Guardian _________________________________ Date______<br />

You will receive a receipt with each payment. Please be sure to keep this for<br />

accounting purposes.<br />

--------------------------------------Do Not Write Below This Line---------------------------------<br />

Student _______________________Parent/ Guardian ________________________<br />

DEF<br />

1. ______________ $______________ # _________________<br />

2. ______________ $______________ # _________________<br />

3. ______________ $______________ # _________________<br />

4. ______________ $______________ # _________________


<strong>The</strong> Dance Blanket Permission Slip<br />

Please Return filled out by Sept 12th<br />

Level_____ Grade ______<br />

<strong>The</strong> following form will serve as a permission slip and medical emergency form to cover all field trip<br />

opportunities and activities that <strong>the</strong> dancer listed below will be invited to participate in with <strong>the</strong> <strong>LaVilla</strong><br />

Dance Department through <strong>the</strong> *2011-2014 school years. Informational forms will be sent home to allow for<br />

parental denial. Please read carefully.<br />

I _______________________ <strong>the</strong> parent/guardian <strong>of</strong> ________________________ do hereby give<br />

permission for this dancer to attend, perform with, be photographed or videotaped by or travel with <strong>the</strong> <strong>LaVilla</strong><br />

Dance Department to all dance related functions for which <strong>the</strong>y are eligible through <strong>the</strong> 2009-2012 school years. I<br />

understand that each activity and event may hold some level <strong>of</strong> physical risk as is expected in this art form. And<br />

do, <strong>the</strong>refore release <strong>the</strong> <strong>LaVilla</strong> <strong>School</strong> <strong>of</strong> <strong>the</strong> <strong>Arts</strong>, <strong>the</strong> dance department, faculty, volunteers, and o<strong>the</strong>r agents<br />

from any legal or financial responsibility or liability in <strong>the</strong> event <strong>of</strong> personal injury, illness, or property damage<br />

during said activities.<br />

In case <strong>of</strong> emergency, every attempt will be made to contact me or any listed emergency contact. I<br />

request that, by judgment <strong>of</strong> chaperones, director, faculty or medical personnel, measures be taken without delay<br />

to correct said illness or accidental injury. This is to say that chaperones, director, faculty or medical personnel<br />

may also transport injured or ill dancer to a medical facility if necessary.<br />

I understand that if any <strong>of</strong> <strong>the</strong>se situations should arise a report will be filed with <strong>the</strong> House<br />

Administration and Main Office. I am notified that I am financially responsible for expenses which may be<br />

incurred during emergency transportation or care.<br />

<strong>The</strong> following may be administered to my child by and adult or medical pr<strong>of</strong>essional<br />

_____Aspirin _____Antihistamines _____Acetametaphin _____ Antibiotics (topical)<br />

_____Antiseptics _____Antacids_____ Cough Drops _____Ibupr<strong>of</strong>en _____O<strong>the</strong>r (Specify Below)<br />

List allergies, conditions or Chronic Illnesses that we should be aware <strong>of</strong><br />

________________________________________________________________________________<br />

(please register all emergency medications in <strong>the</strong> proper areas in House Administration)<br />

Medical Emergency Information<br />

Primary Care Physician ________________________________ Phone Number __________<br />

Family Dentist _____________________________________ Phone ____________________<br />

Dancer’s home # _____________________<br />

Mo<strong>the</strong>r‟s Name ___________________________Work #_________________ Cell # _________________<br />

Fa<strong>the</strong>r‟s Name ___________________________ Work #________________ Cell #__________________<br />

Emergency Contact ____________________________________ Number _____________<br />

O<strong>the</strong>r Contact ____________________________________ Number __________________<br />

**PLEASE DO NOT SIGN UNTIL NOTARIZED. RETURNING DANCERS DO NOTNEED A NEW BPS, IF ON<br />

FILE FROM THE YEAR BEFORE.<br />

*Parent/Guardian Signature _____________________________________________<br />

(Please sign only in presence <strong>of</strong> a Notary <strong>Public</strong>)


Presented to and Sworn before me this ____ day <strong>of</strong> _____________ in <strong>the</strong> year_____<br />

Notary <strong>Public</strong> State <strong>of</strong> Florida ___________________________ Commission Expires _____

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