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D A N C E

- 2012

R E GI ST R AT I ON F OR M New to our school or need assistance in registering?? Please call Mary at 4959914. REGISTER BY...............................................JAN 6...............…JAN 13............After JAN 13 Fee Per Session:

3/4 Hour class 1 Hour class

$ 99 /$25-mo. $114 /$28-mo.

$114 /$30-mo $129 /$35-mo $129 /$33-mo $144 /$38-mo

PAYMENT OPTION : Pay in full (cash, check, debit or credit cards) (or) automatic monthly payment via debit or credit card upon registration and on the 15th of FEB,MAR, APR& MAY.

DANCE ATTIRE: Ballet class – Ballet

shoes, leotard & tights (skirts optional).

Tap class –

Tap shoes & dance attire. Jazz Class – Jazz shoes & dance attire. Dance Attire is a leotard or exercise top and dance/exercise pants. Dance shoes available at our school. No jeans and hair must be tied back. Thank You!

COSTUMES : Costume for May Dance Concert is $55 for child size and $65 for adult size. Costume fee is DUE MAR 15. Discounts will be made on multi costume orders.

FAMILY RATES : 1ST family member pays full tuition. Each additional student from the same family receive 50% discount. All discounts are figured on the lesser class fees. Circle one: Monthly

(or)

Pay in Full

Circle one: Cash

Check

Debit/Credit Card

Card # ______________________________________________________Exp Date ___________ You may put “Card on File” if you have purchased with us in the past. Please write in Expiration Date.

Class Name (1)____________________ (2)____________________ (3)____________________ Student’s Name __________________________________________ Parents’ Names __________________________________________

NO REFUNDS. Mail to: Music & Arts School 606 N 12 th Ave Sturgeon Bay, WI

54235

Address ______________________________________City______________Zip_______________ Phone (home)__________________(work)_________________________(cell)_________________ Ph: (2nd Parent)__________________(work)_________________________(cell)_________________


Age

(not necessary for adults)

_____ E-Mail Address _________________________________________

How Did You Hear About Us (if new to our school) ?_________________________________________ I/We, the undersigned, hereby acknowledge the physical demands and inherent risks involved in dance activity, guaranteeing the registered student(s) to be in sound physical, mental and emotional health. I/We agree to hold Music & Arts School of Door County, LLC, its officers, agents and employees,in both individual and official capacities, harmless from liability for accident, injury, loss or damage to person or property as a result of said student’s participation in any Music & Arts School of Door County, LLCactivities.

________________________________________________________________________________

Parent Or Adult must sign

Date


Dance registration Form 2012