danskostudios 2013/2014 Registration Form DATE Month / Day / Year START DATE Month / Day / Year Student Information NAME BIRTHDATE Month / Day / Year STREET ADDRESS CITY POSTAL CODE Are you a new student? YES NO if yes how did you hear about us? HOME TEL ( ) EMAIL Parent /Guardain/Emergency Contact information CONTACT 1 – NAME CELL ( RELATIONSHIP ) EMAIL CONTACT 2 – NAME CELL ( RELATIONSHIP ) EMAIL Registration Details Dance Class Selections (see reverse) – Please highlight or circle selections on back. Tuition is based on a 10 month term broken into monthly payments from Sept – June. No Pro-Rating REFUND POLICY – No refunds after Dec 1st 2013. One month cancellation fee will apply before Dec 1st 2013. Any class changes after Sept 30th 2013 will result in a $5.00 charge. Changes will only be made once notice to the office has been given otherwise we will use our discretion on fee changes. Registration Fee Initials____ # of classes per week Rates per month Total per month 45 min X 48 = $ 1 hr X 52 = $ 1.25 hr X 54 = $ 1.5 hr X 56 = $ MONTHLY TOTAL of CLASSES $ DISCOUNT $ 5% gst tax $ NET MONTHLY TOTAL Discounts Will only apply if registered before Sept 1st 2013 3 classes 10% 4 classes 15% 5 classes 20% 6 + classes 24% $ Registration Fee will only be waived if tuition is paid in Full – Non Refundable $25 + gst /student and $5 + gst /additional family member Reg Fee Total = $ Costume Deposit $50 Jr /Combo class deposit $60 Int/Sr class deposit $100 Company class Costume deposit is due Dec 1st dansko will email 10 days notice for this amount $ to be debited from your account or credit card (initials) METHOD OF PAYMENT 1) Direct Deposit – Please supply one Void Cheque at time of registration and sign dansko studios debit form 2) Visa/Master Card – If your monthly Fees are under $100/month = Annual Payment If your monthly Fees are under $200/month = Semi-Annual Payments If your monthly Fees are over $200/month = Quarterly payments As a parent/guardian to the named student, I , undersigned, understand danskostudios policies regarding registration, payment, and with drawls. I understand danskostudios and/or the Corporation of the District of Saanich are not liable in any way for injuries sustained during class, or at any related performances or functions. PRINT NAME: SIGNATURE: DATE: Note: Your daughter/son is registered in the classes that you have indicated on this form unless we contact you and discuss changes to his/her registration. Classes begin Monday Sept 9th 2013. Placement in classes is at the discretion of the instructor.