Register for Ballroom or Pilates Privates

Ballroom and Pilates Private Lessons

Thank you for your interest in Ballroom and/or Pilates Private lessons. Please note that these will be scheduled with an instructor and are not built into our weekly schedule. Ballroom privates must have at least two people signed up, and can be taught in groups (additional dancers can be noted in comment section below or specified in a separate registration sheet). The office will contact you to further schedule a time for both Ballroom and Pilates private lessons.

*All specialty privates are taught at our Madison location.

Student(s) Information

Student 1 Name

First Name

Last Name

Student 1 Birth Date

YYYY

Student 2 Name

*Only required for ballroom private lessons.

First Name

Last Name

Student 2 Birth Date

*Only required for ballroom private lessons.

YYYY

Parent/Guardian Name

*If student(s) are under 18 yrs.

First Name

Last Name

Phone Number of Primary Contact

Person to contact for scheduling/billing/questions/emergency (parent or guardian email if student or students are under 18 yrs).

(###)

###

####

Email of Primary Contact

Person to contact for scheduling private lessons (parent/guardian email if student or students are under 18 yrs).

Address of Primary Contact

For billing purposes.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Additional Contact

Please include name and email or phone number if you would like us to have another contact on file.

Billing Information

Person to Bill

First Name

Last Name

Billing Email

Class Information

What type of private are you scheduling?

Pilates

Ballroom

Questions/Comments

For Pilates: tell us your goals, background in dance/Pilates/fitness, physical disabilities or capabilities, anything else you feel is important. For Ballroom: tell us additional dancers you may be bringing besides the original couple, why are you taking ballroom privates, if attending for a wedding what music will you be using, anything else you feel is important.

Statement of Understanding

I hereby acknowledge that I am responsible for payment of all lessons I schedule through the office of Monona Academy of Dance. I must maintain a valid credit card on file for incidentals and/or late scheduled payments. Failure to meet payment criteria will result in cancellation or withholding of scheduled private lessons. I authorize Monona Academy of Dance to use my/my dancer's/participating dancers' photo(s) to promote or publicize the studio online or in print. I understand the physical demands and inherent risks involved in dance and guarantee the registered student to be in sound physical condition. I agree to hold Monona Academy of Dance LLC, its officers, agents and employees in both individual and official capacities, harmless from liability for injury, damage or loss to property or person as a result of participation in any Monona Academy of Dance LLC activities. I hereby agree that I will/my dancer/participating dancers will not attend scheduled private lessons if they are exhibiting any COVID-19 or other flu like symptoms and/or severe cough. I acknowledge Monona Academy of Dance reserves the right to cancel private lessons with adequate notice and will work to reschedule private lessons if appropriate. Billing will occur once private lessons are scheduled and confirmed. Refunds of cancelled lessons prior to 12 hours notice will be given in full minus a 10% processing fee. I have read, understand and will abide by the policies set forth in the Classes Tab of this website and by Monona Academy of Dance LLC. All policies are listed under the Classes Tab.

Signature

Signature accepting Statement of Understanding and agreeing to maintaining a valid credit card on file and authorizing payments on such card. Type your full name. Call studio at 608-221-4535 to provide card number or stop in prior to first payment date to provide card information. Do not email.

First Name

Last Name

Date of Signature

YYYY