STUDENT NAME__________________________________CELL PHONE________________ DATE OF BIRTH________________________________________ AGE ____________ SCHOOL ATTENDING__________________________________ GRADE__________ EXPERIENCE____________________________________________________________ PARENTS MOTHER_______________________________CELL PHONE_____________________ FATHER_______________________________ CELL PHONE: ____________________ STREET ADDRESS________________________________________________________ CITY________________________________________________ZIP__________________ HOME PHONE________________ E-MAIL____________________________________ OTHER FAMILY ENROLLED_______________________________________________ EMERGENCY CONTACT IF PARENT CANNOT BE REACHED NAME____________________________________PHONE_________________________ ENROLL IN THE FOLLOWING DANCE CLASS(ES) or MUSIC LESSON(S) (indicate desired day & time)
CIRCLE DANCE CLASS PAYMENT PLAN: IN FULL 4 PAYMENT PLAN 8 PAYMENT PLAN (MUSIC LESSON PAYMENTS ARE DUE 1st OF EACH MONTH)
CIRCLE PAYMENT METHOD: CASH, CHECK OR CREDIT CARD POST DATED CHECKS ONLINE BANKING AUTOMATIC CHARGE (forms available in the office)
HOW DID YOU HEAR ABOUT The Studio of Dance & Music? Phone Book Newspaper Magazine Drive By From a friend _______________ TheStudioOfDanceandMusic.com“Word Of Mouth” Other:________________
BY SIGNING THIS REGISTRATION FORM, I ACKNOWLEDGE THAT I HAVE READ AND AGREE TO THE 2011-2012 TERMS OF ENROLLMENT AND THE WITHDRAWAL & REFUND POLICY AND HEREBY AUTHORIZE THE ABOVE NAMED STUDENT(S) TO ENROLL AND GUARANTEE ALL PAYMENTS TO THE STUDIO OF DANCE AND MUSIC.
______________ ________________________________________ Date Signature (Parent or Adult Student)
Dance For Joy! Make A Joyful Noise!
If mailing the registration forms, mail to
The Studio of Dance & Music 7313 International Place, Suite 100 Sarasota, FL 34240
