logo.png                                        Registration Form 2008-09                        Account #

Name of Student- First Name

 

Last Name

Parent Name      (if applicable)

 

Student Date of Birth            

Gender

           M                     F

Phone 1

 

Phone 2

Street Address 

                                                                   

 

City

Zip Code

 

E-Mail

Limitations/ Health Issues

 

 

How did you hear about us?  Newspaper, Internet, Referral?

Grade 08/09

School

 

Check all Classes for Enrollment for this student:        New Students check here!  _____

Pre-Dance

Pre-Ballet

        Ballet                           Pointe

Tap

Jazz

Hip Hop

Sacred Dance

Adult Class

Private or Semi-Private

 

2nd Student in Same Family:        New students check here! _______

 

Name of Student- First Name

 

Last Name

Student Date of Birth

 

Gender

           M                     F

Limitations/ Health Issues

 

 

 

Grade 08/09

School

 

Check all Classes for Enrollment for this student:

Pre-Dance

Pre-Ballet

          Ballet                       Pointe

Tap

Jazz

Hip Hop

Sacred Dance

Adult Class

Private or Semi-Private

Registration Fee For this Family   $

            $25 per student   non-refundable        

Date Paid             

Check

 

 

Cash

Charge

Monthly Tuition Rate For this Family       $

Start Date

 

I understand that Cabarrus Dance Academy does not carry medical insurance for students.  The studio will not be held responsible for injuries, accidents or lost articles.  Monthly tuition payments are due in advance on the first day of each month and will be considered late after ten days.  A $10 late fee will be added to any payment made after the tenth of the month.  Tuition may be paid in two semester payments at a 10% discount. Tuition is due until notification of withdrawal is made to the director.  The Registration fee holds one space in a class which is limited in size and is not refundable.         Signature of Responsible Adult:

___________________________________________________________________________________________Date_________________________