Ultimate Dance Etc.

Student's Name:       Age       DOB

 

Street Address:       City:       Zip Code:

 

Phone:       Cell Phone or Work:

 

Grade:       School:       Time school gets out:

 

Parent or Guardian:

 

Parent or Guardian E-mail:

 

Who to contact in an emergency:       Phone:

Relation:

 

Any allergies or any other medical problems that you feel we need to be aware of:

 

Class #1:       Day and Time:

Class #2:       Day and Time:

Class #3:       Day and Time:

Class #4:       Day and Time:

Class #5:       Day and Time:

 

I hereby register in Ultimate Dance Etc. Studio Program

 

I agree that payment for each month will be paid by the first class of each month. I agree to pay $10.00 per month late fee for any payment made after the 10th of each month. I further agree to pay a $20.00 fee for any check returned by the bank. I also agree to pay $20.00 registration fee.

 

I agree to pre- pay for the Fall session in full at the time of registration and receive 1 month free if registered by July 1st or ½ month free if registered after July 1st and before Sept 6th. I will also have my registration fee waived.

 

I also understand that tuition is based on a bi-annual basis and not pro-rated monthly. Some months may have more classes than others due to extra practices, performances, and holidays. Tuition must be paid whether class is attended or not.

 

RELEASE - I hereby release Ultimate Dance Etc. and all staff and officials from any claims of damages or injury suffered by the above-registered student in connection with or by their association with Ultimate Dance Etc. This includes my heirs, who may not act in our behalf. I have read and understand the terms of the above contract, and agree to abide fully by its terms. I have also read and understand the program and policies attached on this contract.

 

Name of person completing this electronic form: