MEDWAY DANCE AUTHORITY 2008 – 2009 REGISTRATION FORM (one form per student please) __________________ may register for Level_____________________________________ STUDENT’S NAME _______________________________________________________________________ PARENT’S NAME ________________________________________________________________________ STUDENT’S BIRTHDATE ________________ EMAIL___________________________________________ STUDENT’S ADDRESS ____________________________________________________________________ TOWN ____________________________________ ZIP CODE_____________________________________ PHONE NUMBER ______________________ CELL PHONE______________________________________ EMERGENCY CONTACT (OTHER THAN PARENT) ___________________________________________ EMERGENCY CONTACT PHONE NUMBER __________________________________________________ RELATIONSHIP TO STUDENT _____________________________________________________________ ALLERGIES/PHYSICAL LIMITATIONS ______________________________________________________ _________________________________________________________________________________________ PHYSICIAN’S NAME_______________________________ PHONE________________________________ PHYSICIAN’S ADDRESS___________________________________________________________________ INSURANCE______________________________ POLICY NUMBER_______________________________ PREVIOUS DANCE EXPERIENCE: DANCE SCHOOL _________________________________________________________ YEARS _____________________________ TYPE OF DANCE______________________________________________________________________________________________ PHOTO RELEASE I, ___________________________________, give the Medway Dance Authority permission to use my child’s photos from studio events for use on The Medway Dance Authority Website, Newspaper Advertisements and Studio Brochures. REGISTRATION FEES $25.00 Single Student Registration Fee is Due or $40.00 Family Registration Fee Is Due All currently enrolled students may register as of April 1st – NO SOONER!!! Forms turned in early will be returned. Siblings, except age 3, must wait until April 15th to enroll. Siblings forms must still be turned in before April 15th for preferred placement over new students from outside the school. Registration forms may be mailed to: The Medway Dance Authority P.O. Box 150 Medway, MA 02053 Priority enrollment for current students will be April 1st – April 14th. Registration will be first come, first serve during this time for current students. If you need a particular day and time you should try to register early. You may enroll by filling out this registration form and enclosing it in an envelope with your registration fee (see fees above). Please make sure you fill in the correct day, time, and cost of classes. Please see me first if your child wishes to try a new style of dance. His/ Her class may not be the level indicated above and he/she may need to wait for a slot to open. If you do not hear from us your child will automatically be enrolled in the programs you have requested on the back of this form. If a class is full we will contact you immediately! Please call 533-9171 with any questions you may have! REGISTRATION FORM & CONTRACT Please register my child, _________________________________ for the 2008/2009 dance season. I have enclosed my non-refundable registration fee of $25.00 for a single student or $40.00 for a family registration to register for the classes below. I will contact The Medway Dance Authority by September 1, 2008 if we will not be able to attend the 2008/2009 season. I understand that tuition is always due by the 1st day of each month (September 1st – June 1st ) and that I will be charged a $10.00 late fee after the 1st day of the month. I understand that I will NOT receive the 10% multi-class discount if my payment is late and will also be required to pay the $10.00 late fee. I also agree to pay a $20.00 penalty for any returned checks. I understand that the costume payment of $60.00 per class is due by October 15, 2008. This payment must be made separate from tuition and is non-refundable. However, if the costume payment has been made, but the child is unable to continue in the dance program, he/she will still receive his/her costume. I understand my payment options. I understand that payment may be made in full for the year by September 1st or I may choose to make 10 equal payments September 1st – June 1st. I understand that tuition is based on the dance season, not based on how many classes per month. I understand that my child must follow all studio rules and safety regulations. My child will also be at class on time so that he/she will not miss critical warm up exercises. I understand and my child understands that by missing class time and by not following rules, he/she runs the risk of injuring himself/herself. I also understand that with any physical activity, including dance, there is always a risk of injury and I will not hold The Medway Dance Authority responsible for any injuries. I, ____________________________________________________ and my child____________________________________________ will follow all of the rules & regulations of The Medway Dance Authority as outlined in the handbook. 2008/2009 handbooks must be signed out by a parent or guardian at the first dance class. Please register ___________________________________________ for the following classes. CLASS DAY TIME COST YEARLY TUITION TOTAL MONTHLY TUITION TOTAL --------------------------------------------------------------------------- Families enrolled for more than 1 class may take a 10% discount monthly if payments are made by the 1st day of each month!!! 1ST payment of monthly installment payment plan due by September 1, 2008 Receive a 5% discount if full year is paid by June 15, 2008 (May be combined with 10% multi –class discount if you are eligible) REGISTRATION FEE DUE NOW!!! $25.00 single student/$40.00 Family ______I choose to Pre-pay the 2008/2009 Season by June 15, 2008 to receive the 5% Discount (Multi-class discount may also be added if applicable, for a savings of 15%) Payment may be dropped off or mailed to: The Medway Dance Authority P.O. Box 150 Medway, Ma 02053 ______I choose to pay for the 2008/2009 season in full by September 1, 2008 (10% Multi-class discount may be taken ) ______ I choose to break my 2008/2009 payment into 10 payments, due September 1, 2008 through June 1, 2009 (10% Multi-class discount may be taken if payments are made on-time (by the 1st DAY of each month, not the 1st class) The multi-class discount may not be taken if payment arrives after the 1st day of the month. A $10.00 late fee will also be due if payments are late.) OFFICE USE ONLY REGISTRATION FEE PAID BY: CASH OR CHECK #__________ ON / / If paying in full, please indicate amount and date paid: $______________ on / / |
Registration Form 2008 ~ 2009
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