Great Lakes Dance Centre Registration Form ___ / ___
33435 Harper Avenue, Clinton Township, Michigan 48035, (586) 792-5003
Name of Student ___________________________________ Returning _____ New_____
Address ____________________________________ City___________ Zip____
Phone______________ Age _______ Birthdate______/______/______
Parent’s Name __________________________________ Cell Phone__________________
Lessons Desired__________________________________ Email_____________________
Day and Time ______________________________________ Years at GLDC___________
Tuition Payment Schedule: ($20.00 late fee will be added to all payments received after the
10th of the month. No exceptions.)
The dance season consists of 40 class sessions, class tuition fees are based on 10 months, payable in 9
months.
Payment Schedule is as follows, ALL PAYMENTS DUE BY THE 1STof the MONTH
Sept/June (First & Last Month)
February
October
March
November
April
December (plus $25.00 costume deposit)
May
January (plus balance of costume)
Yearly Registration Fee $20 per family. Registration Fee & Tuition payments are non-refundable
A one month notice is required when cancelling classes, or next month payment is your responsibility.
Monthly Payment ______________________ Check _______ Cash ________
Please read the following carefully. This must be signed and returned.
I understand dance, acrobatics and exercise involve some risk, therefore, I, the undersigned do hereby
expressly release and waive any and all claims, demands and actions against Stephen W. Hadala and
Kathryn M. Short or Great Lakes Dance Centre, for any and all injury, loss or damage, whatsoever
sustained as a result of my or my child’s participation in the dance, acrobatics or exercise classes of
Stephen W. Hadala, Kathryn M. Short or teachers associated with or representing them or Great Lakes
Dance Centre.
I have read and understand the above payment schedule and release.
Student______________________________________________
Signature of Parent/Guardian ___________________________ Date ___________________________