REGISTRATION Form (2015

advertisement

DONNA MARIE’S STUDIO OF DANCE

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:___________

Download