| Elite Dance Co. Registration Form Student First Name: ___________________ Student Last Name: _____________________________ Parent First Name: ____________________ Parent Last Name: ______________________________ Address: Email Address: _________________________________ ______________________________________ City: _____________ State: ____ Zip: _________ Home Phone: _____________________________ Work Phone: ______________________________ Cell Phone #: _____________________________ Child’s Birth Date: _________________________ Emergency Contact Name: _________________________________ Phone: _______________________ Please list below any health issues your child might have: __________________________________________________________________________________________ Monthly Class Tuition: 1.0 Hour $35.00 2.0 Hours $65.00 3.0 Hours $85.00 1.5 Hours $52.00 2.5 Hours $75.00 3.5 Hours $95.00 Monthly/Quarterly tuition is due by the 10th to avoid a $10 late charge per monthly billing period. **Please indicate whether you would like to be billed **MONTHLY** **QUARTERLY** (Quarterly accounts receive 5% discount-not applicable to monthly competition dues) To reserve your child’s spot in an available class, please return this registration form and $25.00 registration/insurance fee to: Elite Dance Co. 131 S. Stewart Road **Registration/Insurance Fee is NON-REFUNDABLE** Liberty, MO 64068 Class Name/Type Day Time Class Length ______________________________________________________________________________________________ ______________________________________________________________________________________________ We understand that activity involving excessive motion can cause accidental injury. In compliance with the registration into this dance program, we agree to indemnify ourselves to pay for any and all treatment incurred with activities concerning the dance and tumbling program along with any traveling performances, including Elite Dance Co. Our primary session follows the standard school year, September through June. If removal of your child from their enrolled class is necessary, we do ask for a 30 day written notice. Because of our limited class sizes, if a 30 day notice is not provided, you are responsible for 30 days of class tuition from your removal date. Parent Signature: _____________________________________________ Date: _________________ |
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