Application for Registration 2015-2016

Registration Fee: $45 Per Year

Student’s Name: ____________________________________________________________________

Age: _______ Date of Birth: _____________ Location: NC or AL_______________________

Mailing Address Including Zip Code: ___________________________________________________

__________________________________________________________________________________

Mother’s Name: _________________________________________________

Mother’s Place of Employment: _________________________________________________________

Home/Work Phone: _______________________ Cell Phone: __________________

Father’s Name: ____________________________________________________

Father’s Place of Employment: __________________________________________________________

Home/Work Phone: ______________________ Cell Phone: ____________________

Best e-mail address: ___________________________________________________________________

Name of school that your child attends: ________________________________________________ Grade: ______________

Number of Years in Dance: _____

Please indicate which class or classes you desire for your child to attend:

Class Day Time

Important Note: Tuition is based on registration information and is due by the 1st of the month. Parents must contact the studio office to make changes regarding class registration. Absence from class is not considered withdrawal. If you withdraw your enrollment, you must register upon your return, subject to class availability. Student tuition is not prorated due to illness or holidays. Refunds will not be given. Furthermore, I understand that the utmost care and training is exercised to prevent injury and appreciate the risk involved with the physical activity of dance and gymnastics. I agree to hold harmless Applause Dance Studio, its owners, instructors, or director, liable for any injury which may occur.

Parent’s Signature: ___________________________ Date: _____________________________