Miss Mona's School of Dance & Performing Arts
Student Registration Form
146 West 4th St.
Salem, VA 24153
(540) 387-9575
www.missmonas.com
letsdance@missmonas.com
Student's Name ___________________________________ Date _________
Parents' Names ___________________________________
Address ________________________________________________________
City
________________ State _____________ Zip ______________
Home Phone ________________ Parents’ email (required) ______________________
Birth Date ___________ School _______________________ Grade ___________
Mother's Employer _______________________
Work Phone ____________________
Cell Phone ___________________
SS# _____________________________
Father's Employer ___________________ Cell Phone _________________
Work Phone _____________________
SS# ___________________________
How did you hear about Miss Mona’s? _______________________________
_____________________________________________________________
Previous Dance Training?
Yes
Previous Student at Miss Mona's?
No
"If yes, where?"____________________
Yes
No
If yes, when?" _______________
Is there any day or time that you cannot attend class? __________________
If another party is to be contacted regarding your financial statement, please list their name, phone #,
and email address here:
______________________________________________________________________________
----------------------------------------------------------------------------------------------CONSENT AND INSURANCE
I have read the rules and regulations listed on the attached page and I understand and agree to all terms
and conditions.
INSURANCE WAIVER
I agree that I will not hold Miss Mona's School of Dance & Performing Arts, its faculty, staff or its landlord
liable for any illnesses or injuries that occur while attending dance classes, nor will they be responsible for
loss or damage to personal property.
Signature of BOTH Parents/Guardians ___________________________
Date __________
____________________________ Date __________
Please initial that you have received:
_____ Student handbook
_____Recital Handbook ________
POLICIES- please keep for your records
ABSOLUTELY NO FOOD OR DRINK IS ALLOWED IN THE STUDIO. ONLY WATER FOR
DANCERS.
REGISTRATION FEE
A $15.00 fee is required with the registration form to reserve class space. The registration is not considered
complete until this fee is paid. This fee is non refundable.
REFUNDS
Refunds are only given due to serious illness or surgery, or when a student has moved out of state. After the
first or second class, if the instructor feels that a beginner student is not ready to participate in class we will also
give a partial refund, but this rarely happens. We will give prorated refunds if a family is moving out of state.
Refunds are not given just because the student no longer wants to take classes.
You will continue to be charged tuition, costumes, and all applicable fees until a written notice of
withdrawal from classes is received by our office.
COMMUNICATION___________________________________________________
Miss Mona’s provides information through monthly newsletters, occasional handouts, notices on the bulletin
board, scheduled parents’ meetings, and our website. Occasionally we will send information via email as well.
Parents are responsible for being sure they are receiving all information by picking up monthly newsletters from
the studio office each month. We cannot be responsible for parents missing information that has been
distributed in one of the above ways, so please be diligent about staying informed of studio activities, fees, and
due dates.
TUITION
Tuition for each month will be due before the 10th of each month. Tuition remains the same whether it is a
standard month, a 5 week month, or a 3 week month, and regardless of absences. Studio closings will be noted
on our website, or announced ahead of time. YOUR CHILD’S NAME MUST BE ON THE CHECK TO
INSURE IT IS CREDITED PROPERLY.
LATE CHARGES
A compounded late charge of $15.00 per month is strictly enforced. Lesson money is due BY THE10th OF
EACH MONTH. There will be absolutely no exception to this rule. Late Charges will be assessed every month
the outstanding balance remains due. Late charge for December and May is $25. No exceptions.
If it is necessary for the account to be referred to an attorney for collection there will be attorney fees of thirtythree and one-third percent (33 1/3%) of the unpaid balance plus all court costs. Late charges will be added to
costume and recital payments as well.
RETURNED CHECKS
There will be a service charge for $45.00 on all returned checks
SAFETY
Please be prompt in picking up your child after class. Students are not allowed to leave the school premises
unless picked up by a parent. All students are to stay inside the studio. Parents of Tiny Tots and Preschool need
to be inside the studio 10 minutes before the end of class.
PICTURE RELEASE
Miss Mona's School of Dance and Performing Arts has my permission to use my child’s picture for advertising
and publicity purposes unless otherwise noted on this form.
RECITAL
Our recital is held in May and the date is announced the previous fall. Please reserve that week now because
your child will be involved in rehearsals that last w eek. All students are entitled and encouraged to be in
recital, but it is not mandatory. NO ONE IS ALLOWEDTO MISS STAGE REHEARSALS FOR ANY
REASON. Failure to attend will result in the student not being able to participate in the performance. Costumes
are paid for by the students and furnished by the studio. A deposit is taken and the balance is paid for before the
costumes are given out. Additional deposits on costumes can be made by you anytime during the dance session.
If you are paying tuition or other charges at the same time you are making a costume deposit, please specify on
you check the amount that is to be applied to the costumes. Costume deposits are NON REFUNDABLE. Our
policy regarding recital fees and tickets will be discussed during parent meetings prior to recital. The recital fee
is non refundable. A recital commitment slip will need to be signed by a parent or guardian for all children that
will be participating in the recital. Once the commitment slip has been signed you will be responsible for all
of your outstanding recital balances including costumes and recital fees, even if your child does not
participate in the recital.. Your payment envelope must accompany your tuition and any deposits, etc. Failure
to use the payment envelope will result in a $5 charge to your account. This includes credit card payments.
Your recital handbook and additional parents meeting will cover all information regarding recital and
performances in detail.
INCLEMENT WEATHER
Miss Mona’s will close if Roanoke County OR Salem schools close for bad weather. We do not close for
teacher workdays, etc. Any other cancellations will be announced ahead of time, or listed on the studio calendar
on our website. Please watch the local news for school cancellations if weather is questionable.
PARENT FINANCIAL RESPONSIBILITY
Due to problems we have encountered in the past, we are requiring the information from both parents to be
listed on the registration forms from this point forward. Please note that this information will be kept private
and confidential and will only be used in the event that a past due balance is not resolved by the responsible
parties, requiring us to pursue collections.
If a third party is responsible for the financial obligations on your behalf, please supply them with any pertinent
studio information and forms as well. We also will need to have the responsible party’s contact information in
the event that we need to discuss an outstanding balance.
Contact Information:
Mailing Address:
Miss Mona’s
146 West 4th Street
Salem, VA 24153
Phone:
(540) 387-9575
Website:
www.missmonas.com
Email:
letsdance@missmonas.com