2012-01-03_PR_Packet - Laserfiche WebLink

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a allerinas 2012 'Id 111R osevih% Sd oo'. of'!Daxice J. �h I mm :30 6pm_ `Wed,nesdays 51 ]Ilosevia,',Lle S]1,ca:1,1'L]n.g, b 't 5 (no class an. 8 Plrog 290'[ 62 jan.4'I"e] Plrog wt t 290][ 63 IF`e]b 2j9Ap:ri'1. ][8 (no Glass ]M[a 4, A m iiii 4 $641, Pafks and Recreabion Get your preschooler moving creatively through music and movement. Created for your little ones who are not quite ready for a full dance year.This class introduces the basics of ballet through music and movement.White Ballet shoes requ3Lred.You may take this class season by season. A special class presentation will be held on the last class night. .................................................................................................................................................................................................................................................................................................................................................................................................................... Register: Online: www.cityofroseville.com/parks—By Phone: 651-792-7110 Fax: 651-792-7100 In Person:Monday-Friday 8-4:30 p.m. or By Mail: Checks payable to Roseville Parks&Recreation Send completed registration form with check or credit card payment to: Roseville Parks and Recreation,2660 Civic Center Drive,Roseville MN 55113 Baby Ballerina prog# Dancers Name: Phone Number: Address: City/State/Zip: Email: Date of Birth: Form of payment: Cash (in person only) Check Visa Master Card Ameri Express Credit Card Number Exp.Date Cardholder's Name Cardholder's Signature Liability waiver:I understand that participation in this activity is completely voluntary.I recognize that there are risks in my participation in this activity.I agree to accept those risks.I also agree,in consideration for my being allowed to participate in this activity,and on behalf of myself,my heir,executors,administrators and assigns,to release and discharge the City of Roseville,sponsor(s)of the event or activity,and their officers,employees,agents,successors and/or assigns from liability for any and all injury,damage or loss that is or may arise from my participation in this activity.Data Practices Act Notice:Pursuant to the Minnesota Government Data Practices Act,you are being requested to furnish certain information that is classified as private under the Act.The City collects such information in order to properly process requests to participate in activities.You may refuse to provide such information,but such a refusal may affect your ability to participate.The information will be maintained by the City Park and Recreation Department,and may be accessible to anyone in the Department,or in other Departments of the City.