BRIDGET’S DANCE STUDIO REGISTRATION FORM-
2010 - 2011
Student Name:_______________________________________________________________________
Birthdate__________________ Age___________ Grade For Fall 2010____________
Parent Name:______________________________________________________________________
Address___________________________________________________________
City________________________________State_________________Zip____________________
Home Phone____________________________Cell Phone______________________________
Email:___________________________________________________
Bridget’s Dance Studio will be sending out periodic weekly newsletter with information and updates. In order to receive this information, your email address must be included on this form.
Emergency Contact_____________________________Contact Phone___________________________
Physician Name__________________________Physician Phone_______________________________
Known Medical Conditions______________________ Allergies?________________________________
Taking Medication?____________________ If so what? _______________________________________
Registration and Recital Fees are due with this registration form. No student will be enrolled in classes without payment.
Registration Fee: $10.00
Recital Fee: $20.00- Per Student or $35.00 Per Family (For families with multiple students enrolled)
No Recital Fee for Summer.
I am interested in taking the following classes: (Circle One) Summer 2010 Fall 2010
Please list the day and time you prefer.
Day.____________________________________________Time.________________________________________
Day.____________________________________________Time._________________________________________
Day.____________________________________________Time._________________________________________
Payment for classes is due on or before your first day of classes at the studio.
By signing the enrollment form as a participant or guardian of participant: I agree to abide by all rules and regulations set forth by Bridget’s Dance Studio. All cancellations must be received with a 15 day notice and tuition due by dates set. All late payments will be subject to a late fee of $30.00 at director’s discretion. To the best of my knowledge there are no physical limitations that would prevent from participating in the program.Participation in said program is at my own risk and the place of buisness or Bridget’s Dance Studio is not responsible for any injuries that may occur.
Signature_____________________________ Date:____________________________
|