GRACIES GUYS AND GALS

DANCE STUDIO

REGISTRATION FORM

2009-2010

Students Name _____________________________________________ Age__________________________

Address___________________________________________________ Date of Birth___________________

_________________________________________________________ Home Phone____________________

Email (PLEASE PRINT)_____________________________________________________________________

Fathers Cell _____________________

Father’s Name______________________________________________ Father’s Work __________________

(Please list last name if different) Mothers Cell ____________________

Mother’s Name_____________________________________________ Mother’s Work__________________

(Please list last name if different) Alternate # _______________________

How did you find out about Gracie’s Guys and Gals?________________________________________________

Previous Dance Experience_____________________________________________________________________

CIRCLE THE DESIRED 45-MINUTE DANCE SUBJECT(S)

TAP HIP HOP BALLET POINTE PRESCHOOL COMBO POMS/JAZZ COMBO GYMNASTICS

5 YR OLD COMBO 6 YR OLD COMBO 7 YR OLD COMBO JAZZ/FUNK HIP HOP/FUNK

1st CLASS DAY AND TIME_________________________ 2nd CLASS DAY AND TIME__________________________

($45.00) ($40.00)

3rd CLASS DAY AND TIME_________________________

PLEASE READ AND INITIAL THE FOLLOWING TERMS:

_____ I give permission for my child to participate in dance/gymnastics programs at Gracie’s Guys and Gals Dance studio and will not hold any staff member at Gracie’s Guys and Gals Dance Studio liable in case of an emergency involving my child during class participation, or arrival/departure from the building.

_____ I am aware that the studio guidelines and monthly newsletter are posted in the lobby, and also on the website, for me to read, and it is my responsibility to make sure that I am aware of all the information provided!

_____ It is my understanding that by signing this contract, I will not be allowed to videotape the dance recital held in June. I will inform my guests of this policy. I may videotape the dress rehearsal, but if at the recital I arrive with a video camera, I will be asked to leave.

_____ Tuition is based on a years tuition but is pro-rated on a monthly basis: if my child withdraws, it is my responsibility to notify the

office in writing.

_____ Tuition payments are due by the 7th of each month. Late payments received after the 7th will be charged a $20.00 late fee.

I UNDERSTAND THIS AGREEMENT:

_________________________________________ ________________________________________

PARENT’S SIGNATURE DATE

To be completed by Gracie’s staff

(Bookkeeping: Paid ______________+ Reg. Fee_____________ = ____________ check no. _________)

_{Registration Fee: $35 per family}