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FOOTPRINTS DANCE STUDIO Registration Form 2010-2011

Student’s Name (Last, First, MI)

Parent’s Names (First & Last Name)

Address

City

Zip

Home Phone

Mother

cell

Father

cell

Other

E-Mail Address

(Used

only for communication purposes)

Birth Date

Age

School

Grade

New Students Only: Yrs in training: Ballet

Pointe

Tap

Jazz

Contemporary

other

Studio last attended:

How did you hear about our studio?

Year

I acknowledge that I have received, read and will comply with the Studio Policies. I will not hold Footprints Dance Studio, LLC or any of its agents, employees, or representatives liable for any injuries sustained or illnesses contracted by me while a student attending this studio.

Student’s Signature

Parent’s Signature (If student is under 18 yrs)

Class

Day/time

Class

Day/time

Class

Day/time

Class

Day/time

Class Assignments

Class

Day/time

Class

Day/time

Class

Day/time

Class

Day/time

“Siblings” also attending studio: names & # of hours

Total # hrs / week

TUITION AND PAYMENT INFORMATION Non-Refundable Registration fee:

$

Total monthly tuition $

(Due on the 1 st class day of each month

$20 Late Fee added after 10 th of Month.)

September tuition:

$

10%Disc w/ Full Yr Tuition Pymt $

TOTAL DUE NOW:

$

Footprints Dance Studio LLC 10125-B South Sheridan Tulsa, OK 74133 (918) 845-6988 www.footprintsdancestudio.com