125 KENT STREET PORTLAND, MI 48875
(517) 647-6179
2015-2016 ENROLLMENT FORM
STUDENT’S NAME:___________________________________ AGE:________ BIRTHDATE:____________
PARENT’S NAME:_______________________________________________________________________
ADDRESS:_________________________________________ CITY:________________ ZIP:____________
HOME PHONE:_________________ CELL PHONE:___________________ WORK PHONE:_____________
EMERGENCY CONTACT:____________________________________ PHONE: ______________________
CLASS:_____________________________ DAY/TIME:___________________ TEACHER:______________
CLASS:_____________________________ DAY/TIME: __________________ TEACHER:______________
CLASS:_____________________________ DAY/TIME:___________________ TEACHER:______________
DOES YOUR CHILD HAVE ANY HEALTH OR MEDICAL CONCERNS THAT WE SHOULD BE AWARE OF?______
IF YES, PLEASE EXPLAIN:_________________________________________________________________
I release Donna Marie’s Studio of Dance, its officials, independent contractors, and all other associates from liability for harm, theft, or injury that may be suffered by me and/or members of my family traveling to, from, or during participation in activities/programs sponsored by Donna Marie’s Studio of Dance.
Tuition of $38.00 per month is due by the 1 st day of the month. Tuition is based on a monthly fee; regardless of the number of weeks or classes scheduled in the month. **IF MY TUITION IS LATE, I WILL BE CHARGED A $10
LATE FEE.** I understand if my child’s class fee is not paid in full each period, my child will not be able to participate in class.
May tuition includes: registration, regular classes and rehearsals. It is due at the time of registration and is nonrefundable.
If my child or I participate in the recital, I agree to pay a non-refundable fee of:
$47.00 recital fee (due by May 1, 2016)
$35.00 costume deposit (due before Winter Break) and the remaining balance due by January 12, 2016. If the student drops a class after the costumes are ordered, full costume payment is due.
I understand that I must notify Donna Marie’s Studio of Dance in writing. If my child drops their class, and I am responsible for the entire month’s fee(s) until the form is submitted.
I understand no cameras or video cameras are allowed in the auditorium during the recital.
I understand the above guidelines.
Signature:_____________________________________________________________ Date:___________________
Special Offer – FULL YEAR PAYMENT DUE NO LATER THAN AUGUST 1, 2015 For office use only:
(Discount included below – TUITION ONLY!)
1 Class (Full year): $307.80
2 Classes (Full year): $591.30
3 Classes (Full year): $858.60
Amount paid:________
Check #:____________
Date paid:___________