Classical Dance Center, Newport Beach
Registration Information Card
By signing this registration card you agree to adhere to the rules and tuition policies of
the Classical Dance Center.
• All Tuition is due on the first class of every month. Any payment received after the 7th of the month is
considered late and you will be charged a $15.00 late fee.
• Tuition will not be pro-rated during any months except the month you join the studio. Full tuition is due
every month. Months with 5 classes will not be charged an extra fee.
• Registration fees and tuition are non refundable or transferable.
• Missed classes cannot be used as payment toward tuition.
• Miss classes may be made up in any age/level appropriate class. You have 60 days to make up your missed
class as long as you are currently paying tuition for that month. Please obtain a make-up card from the
front desk.
• Medical disabilities will be pro-rated if requested only with a written Doctor’s statement.
• We reserve the right to refuse service or admittance to anyone.
Student’s Name____________________________________________ Age_____________
Address______________________________________________________________________
City___________________________________________ Zip_________________________
Home Phone__________________________________ Cell__________________________
Emergency Name and Number___________________________________________________
E-Mail______________________________________________________________________
Father’s name___________________________ Mother’s name________________________
Today’s date____________________________ Date of Birth__________________________
How did you hear about us?____________________________________________________
*Class______________________________ Day_________________ Time____________
*Class______________________________ Day_________________ Time____________
*Class______________________________ Day_________________ Time____________
*Class______________________________ Day_________________ Time____________
Insurance Waiver and Release
I give my permission for any Classical Dance Center Newport Beach staff to call a doctor in the event of an
emergency. I recognize the risks of injury inherent in any dance exercise program and I am participating in the
Classical Dance Center Newport Beach program upon the expressed agreement and understanding that I am
waiving and releasing Jacquelyn Happoldt and the Classical Dance Center Newport Beach and staff from any and
all claims, costs, liabilities, expenses, judgments, including attorneys fees and court costs (herein collectively
“claims”) arising out of my participation in the instructional programs, performances, and /or rehearsal
participation and any and all participation in any event or program given or sponsored by the Classical Dance
Center Newport Beach or any illness or injury resulting there from. I hereby further agree to indemnify and hold
harmless Jacquelyn Happoldt and the Classical Dance Center Newport Beach from and against any and all such
Claims except Claims proximately caused by the gross negligence or willful misconduct of the Classical Dance
Center Newport Beach.
I understand that students must be picked up directly after their class and if the student leaves the studio, for any
reason, Classical Dance Center Newport Beach will not be held responsible. Students must wait inside the studio
for parent’s to pick them up.
I also understand that I can be charges a $15.00 late fee if my monthly tuition is not paid before the 7th of each
month.
I have read and agree to comply with all the policies at Classical Dance Center Newport Beach.
Parent’s Signature_________________________________________ Date _________________
Classical Dance Center Newport
Permission to Use Photograph
Subject: Dance Class and/or Dance Studio related activities
I grant to Classical Dance Center Newport, its representatives and employees the right to take photographs of
me/student and my property in connection with the above-identified subject. I authorize Classical Dance Center
Newport , its assigns and transferees to copyright, use and publish the same in print and/or electronically.
I agree that Classical Dance Center Newport, may use such photographs of me/student (with or without my name
upon request) and for any lawful purpose, including for example such as publicity, illustration, advertising, and
Web content.
I have read and understand the above:
Signature, parent or guardian________________________________________
(if under age 18)