Plies Dance Academy

This form can be completed by printing and mailing to: 604 Tanglewood Blvd, Sikeston, MO  63801 

                               FAMILY REGISTRATION FORM

Phone: 573-471-3638

Last Name:________________________ Home Phone:________________________

Address______________________________________________________________

(Street) (City) (Zip)

Cell Phone_______________ Work Phone______________

E-Mail_______________________________________________________________

Emergency Name & Phone_______________________________________________

  (other than parent)                                          

Student’s Name:___________Date of Birth____/____/____ Age/Grade Fall ‘10______

Student’s Name:___________Date of Birth____/____/____ Age/Grade Fall ‘10______

Student’s Name:___________Date of Birth____/____/____ Age/Grade Fall ‘10______

Please list all classes by student first name below:

Student                         Name of Class                       Day & Time                Tuition

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________                                                                                                INITIAL PAYMENT:

 

Please indicate method of payment:                 Registration Fee: $35.00 for one student and                                                                                                           $40.00 (per family)   

Make Checks Payable to:                                  Total:______________________

  PliesDanceAcademy                                      Balance:___________________                                        

                                                                        

Check (number) ___________      ($25.00 fee for returned checks)                                     

Signature ________________________________________________Date _________

               TUITION AGREEMENT AND WAIVER OF LIABILITY FORM

Mission Statement:

A favorable attitude, a willingness to practice, good attendance and parental support are key factors for accomplishment in our school. A majority of our dancers will choose not to become professional, still we feel it is very necessary that they receive the highest standard of quality in training, for their Plies Dance Academy experience will always enhance whatever vocation they follow.

I fully understand and agree to the policy and terms of Plies Dance Academy

I understand that:

 

There are no adjustments or refunds for missed classes.

No refunds unless you cancel two weeks prior to start of class.

Registration Fee is non-refundable.

Tuition is based on nine equal payments and due the first of each month.

A 20% late charge will be applied to overdue accounts.

There is a $25.00 fee for returned checks due to insufficient funds plus additional bank fee.

In the event of inclement weather, Please call the studio for prerecorded cancellation notice.

Failure to comply with any of the above or any of our etiquette guidelines will result in immediate dismissal from the program.

Please refer to calendar posted inside the studio  and on our web site for scheduled vacation and holiday closures.  Web address: www.pliesdanceacademy.com


Dance student acknowledges, agrees and understands that dance training can be hazardous to some individuals and may result in injury to dance student or other dance students. Dance student agrees that in consideration for permission to enter onto the premises of Plies Dance Academy, Dance student assumes all risks of injury incurred or suffered while on and/or upon the premises of Plies Dance Academy, and releases and agrees not to sue Plies Dance Academy, its agents, servants, associations, employees or anyone connected with Plies Dance Academy for any claim, damages, costs or cause of action which Dance student has or may have in the future as a result of injuries or damages sustained or incurred while on and/or upon the premises of Plies Dance Academy.

_______________________________________________________Relationship                                                         Parent Name (Print) (if under 18 years of age)

_________________________________________ Date________________

(Signature)