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Registration Form

About us Director/Owner Handbook" UPDATED Classes Offered Studio Hours Fall Schedule 2010 Registration Form Nutcracker 12/2009 Mission Statement Sydney Peyton's Bday Pay now What's Happening  Center Closings Guest Book



 

Print Name of Student
Age
Grade in School as of Sept. 2010
Parent or Guardian Name
Email Address
Do not write in this space
Reg. pd______________
Check #_____________

Total paid: _________________
Bal. due:_____________

Mailing Address
City/State:   
Zip

Home:  Cell

Pay by: Paypal on site

In case of emergency call:
Name:

Phone:

Cell:

List Dance Training:
Studied: (circle) ballet, pointe, jazz, tap, hip hop, other:

Where: Number of years:
List any physical limitations:
Injuries:
How did you hear about us? (please check)
Website Friend Driving By Phone Book Newspaper Other:

Session: Your start date to
Check: Child Teen Adult
Enrolling for: (circle) Mon. Tues. Wed. Thurs. Fri. Sat.

Circle: * Ballet * Pointe * Tap * Jazz * Hip Hop *
Other: ______________________________
Combination Class: * Tap & Ballet *
School Year Season

Class space is reserved. Therefore no refunds or credits can be given for missed or dropped classes . Registration fee, deposits or tuition will not be refunded.

The parent or adult student signing this release acknowledges our policy as stated on the tuition form and understands that his/her child or adult student is taking classes at his/her own risk and agrees to hold Civic Dance Center. its instructors, and/or assignees harmless in the event of any physical injury to the student. Person signing this form is responsible for payment of registration fee, and/or tuition. Registration Fee is $25.00 (New Students) $20.00 (Returning Students) $30.00 Per Family (New/And or returning students). Please enclose with registration form.
Tuition enclosed: $ or deposit of $ is enclosed.
Check # 

X                          X
Date Today                             Parent or Guardian Signature / Adult Student Signature

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