REGISTRATION FORM

(Please Print)

DANCER INFORMATION
Childs Name: Parents Name: Birth Date: / Primary Phone: ( E-mail Address: ) / Secondary Phone: ( ) Age: Comments/Allergies:

Previous Dance Experience:

Street Address:

City:

State: Relationship to family:

Zip:

Emergency Contact (not living at same address):

Home phone : ( ) Banner

Work phone : ( ) Web

How did you hear about us?:

Friend/Neighbor

Flier

Newspaper

City Event

Other (specify): __________________________________________

Referred by: ____________________________________________

CLASS INFORMATION
Course No.: Creative Movement Beginning Ballet Ballet Level 1 Ballet Level 2 Ballet Level 3 Ballet Level 4 Ballet Level 5 Ballet Level 6 Pointe Prep Pointe Day and Time: Wednesday 3:30 Wednesday 4:30 Wednesday 5:30 Monday 5:30 Tues/Thurs 5:30 Tues & Thurs 5:30 Mon & Wed 7:00 Mon & Wed 7:00 Thursday 4:00 Thursday 7:00 3:003:304:304:005:30-7/44:005:305:303:305:30Age: 2-3 No prerequisite 4-6 No prerequisite 6+ No prerequisite 7+ , Level 1 required 8+, Level 2 required Level 3 required Level 4 required Level 5 required By Invitation Only By Invitation Only Registration Fee: $10 for only $10 for only $10 for only $10 for only $10 for only $10 for only $10 for only $10 for only $10 for only $10 for only new students new students new students new students new students new students new students new students new students new students Monthly Amount: $25.00 $30.00 $30.00 $40.00 $50.00 $50.00 $50.00 $50.00 $10.00 $15.00

PAYMENT AGREEMENT

Monthly Amount: $_____________

Each monthly payment from September to May is the same amount regardless of the number of weeks in that month. You may pay on a week by week basis by purchasing a punch card and dancer must have card present in order to take class. Please Note: There is no fee adjustment for illness or when classes are missed. PLEASE SELECT WHICH PAYMENT METHOD YOU PREFER
I agree to pay the monthly rate. I understand this rate is NOT discounted if my child misses class for any reason. ___________ (please initial) I agree to pay on a weekly basis. I understand that I will need to purchase a punch card and that my child will need card present in order to take class. __________ (please initial)

* There is a $5 discount if paid by the first class

of each month

*There is NO discount given with this payment option

Date:____________________________

X________________________________________________________________________________
Signature of Parent or Legal Guardian

Thank you for dancing at

Sur Le Pointe!