REGISTER

Classes Registering for *

Phone *

Parents/Guardians Name *

Email: *

I certify that the above information is correct and that I am the financially responsible party for charges incurred for the above listed student or students. *

PLEASE READ CAREFULLY-In consideration of the opportunity to participate in dance class at Alicia's School of Dance, I individually or, as a parent/guardian on behalf of a minor, do hereby waive, release, discharge any and all rights, demands and claims for damages that I may have against Alicia's School of Dance. I attest that I have full knowledge of the risks involved with dance training, and I assume the responsibility for my own medical and emergency expenses in the event of an accident, illness or any other incapacity. *

Name/ DOB/AGE *

School/Grade *

Previous Dance experience

PLEASE READ CAREFULLY-TUITION PAYMENTS: Are due by the 1st of each month. Any unpaid balances on the account after the 15th of the month will be charged a late fee of $15.00. For students to continue to dance, balances cannot exceed $150.00. Or two months worth of unpaid tuition. All billing discrepancies need to be addressed within 30 days from date incurred. *

PLEASE READ CAREFULLY-ENROLLEMNT(SEPT-JUNE) Changes in enrollment must be submitted in writing. We will hold you or your child's place in the class until such notice is given. There are no refunds on tuition for missed dance classes. *

Medical Information *

PLEASE READ CAREFULLY-COSTUME CHARGES: Costumes are in addition to tuition charges. Costume charges will be paid in advance of receiving cosume-A costume deposit of $10.00 is due with your November tuition. Costumes are ordered early to ensure a good selection, the full cost is your responsibility. Whether the student continues with the class or not, all costumes are non returnable ad non refundable. *

Address *