DeFrances Academy of Dance by PvU21amT


									                                                       De Frances Academy of Dance
                                                                     Registration Form
                                  14040 Coursey Blvd. Baton Rouge, LA. 70817                                     {225} 751-8564
1 Form Per Student!
                    Student’s Name                                 Birth Date            Age {today}         Today’s Date                          Home Phone

                                                                      /         /                                                    {       }
                     Billing Name                                         Billing Address {if different than parent}                              Billing Phone

                                                                                                                                     {       }
                         Student’s Address                                                  City                              Zip                Total Years      Years With
                                                                                                                                                  of Dance         DAof D

                 Mother’s Name                             Mother’s Employer                   Mother’s Work Phone                            Mother’s Cell Phone

                                                                                        {      }                                     {      }
                  Father’s Name                             Father’s Employer                  Father’s Work Phone                              Father’s Cell Phone

                                                                                        {   }                           {    }
List any health issues we should be aware of:                                           Emergency Contact and phone number {other than parent}

     *We sometimes send studio information out by e-mail!                                       How did you hear about De Frances Academy of Dance?

E-Mail Address:
Please check the type of class or classes you would like to take
  Creative        Combination            Ballet              Tap                Jazz            Lyrical            Hip Hop            Cheer Dance        Non Recital Classes

                 School                        Grade       Time School Gets Out        List earliest time of day you can                 Any day you cannot attend
                                                                                       attend class

List 1st. choice class day and time from schedule:                                       List 2nd. Choice class day and time from schedule:

Registration Fee is due at the time of Registration                                           {make checks payable to De Frances Academy of Dance}
$40 Registration Fee {per student}   $80 Recital Fee {per family} includes tickets and 1 program
$55 SC and MC each           $65 LC and Adult each          $75 XL each
   Hours        Monthly        *Yearly        Hours         Monthly        *Yearly       * Discounted yearly tuition must be paid by
  Per Week       Tuition       Tuition      Per Week         Tuition        Tuition      August 15th.
      1           $40            $380           3              $90           $855        *Multiple class discounts apply to the whole family!
     1½           $55            $523          3½             $100           $950        *$50 per hour Private Lessons
      2           $70            $665           4             $110          $1,045       * See Dance Force information for tuition rates
     2½           $80            $760     $10 for every ½ hour after 4 hours
       * 45 min Hip Hop, Creative Movement and Cheer Dance are “specialty” classes and are counted as 1 hour
Tuition is based on 10 months of class including holidays. August – May tuition is charged! Tuition is due on the first lesson of each month. A $10 Late Fee will be added
to your account after the 15th. of the month. A $20 NSF Fee will be charged to your account for NSF checks. Only cash accepted thereafter. No Refunds or deductions are
given if a child misses class for any reason. Ask about “make-up” classes. If for any reason it becomes necessary to withdraw from a class, you must send a written notice to
the office or you will continue to be billed for that class. Costumes and Recital Fees must be paid in full by November 15. You can pay with one payment or in several
installments all due by November 15. After November 15, costumes are ordered and fees cannot be refunded. Recital Fees include 5 or 6 reserved tickets and 1 program per
family. There is no fee for extra balcony tickets. All accounts must be paid in full to receive your Ticket Packet. Only cash will be accepted after May 1st. I agree to let
my child’s picture be posted on the www. website. If my child’s name is used, it will only be a first name with a last initial. All students are expected to
follow the dress code and rules of DAofD. I release DAofD, its owners and associates, instructors, and employees from liability for accident and/or injury which may occur to
and/or from any sort of participation on or around the premises or any related functions at another location.

Parent’s or Legal Guardian’s Signature ___________________________________________________________________ Date ____________________

{For office use only} Received by _______________ Check # _______________ Amount $ _______________

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