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					2009-2010 Volume! Dance Registration Form
Parent/Guardian’s Name(s) _____________________________E-mail Address ________________________ Home Address _______________________________City ________________ Zip Code ______________ Home Phone ____________________ Cell Phone _____________________ Student’s Name ________________________________ Date/Year of Birth _________ School Attending and Grade in School as of May 31st, 2009 __________________________ Student Email Address _____________________________ Cell Phone_____________ Emergency Contact _____________________Emergency Phone _______________________ How did you hear about Volume? If from a friend, please list their name? ___________________

Recreational and All-Star Class Options (Fall) Monday
Baby Ballet (3-5) 5 to 6 pm  Turns and Leaps(Teen) 6 to 7 pm  Team V (Tinys) 6 to 7 pm  Team O (Minis) 6 to 7 pm  Team M (Semi Senior) 7 to 8:30 pm  Jazz (Teen) 7 to 8 pm I  Funky Divas (9-12) 7 to 8 p.m.

Wednesday
 Baby Jazz/Bop (3-5) 5 to 6 pm  Ballet/I Lyrical (Teen) 6 to 7 pm I  Team V (Tinys) 6 to 7 pm  Team O (Minis) 6 to 7 pm  Team M (Semi Senior) 7 to 8:30 pm Adult Fusion /Team N 7 to 8

Tuesday
Adult Ballet/Jazz 10 to 11 am  Creative Movement (2.5) 5 to 6 pm  Team U (Junior Competitive) 6 to 7:30 pm Team E (Senior Competitive) 6 to 7:30 pm  Baby Ballet/Jazz (3-5) 6 to7 p.m.  Hip Hop (9-12) 6 to 7 pm I  II/III Hip Hop (Teen) 7 to 8 pm  Funky Divas (9-12) 7 to 8 p.m.  Team A (Production) 7:30 to 8:30  Adult Dance 8:30 to 9:30 pm

Thursday
Pre -School Dance (3-5) 10 to 11 am  Ballet/I Lyrical (6-8) 5 to 6 p.m. I  Team U (Junior Competitive) 6 to 8:30 pm  Team E (Senior Competitive) 6 to 8:30 pm  Jazzy Funky Divas (6-8) 6 to 7 pm  Technique (9-11) 6 to 7 pm  Team D (Adult Open) 8:30 to 9:30 pm

I understand and acknowledge that there is a risk of injury inherent in dance activities and that personal injury or damage to property may result during participation in dance and dance related activities. I represent that _____________________ (child) is physically able to safely participate in dance and dance related activities. I agree to assume all risks associated with my child’s participation in dance instruction, rehearsal, performance, and all related activities. In consideration, of receiving instruction at Volume! Dance, LLC.. I hereby waive, release, discharge all present and future claims and inabilities of any kind, whether bodily injury, property damage, or other loss arising out of my child’s participation in dance and related activities. I also hereby release Volume! Dance LLC and its staff and volunteers from any liability occurring on or around the Volume premises, or at any function held at other locations. I also acknowledge that I am responsible for delivering my child to the studio and picking him/her up and that the studio is not responsible for a child that leaves the premises. (We ask that you speak to your child about where you will pick him/her up. No student will be allowed to wait outside unattended for you). I also consent to photography and recording of my child for its usage in promotional and public relations, which may include but not limited to, brochures, print ads, and web sites. All photographs and recordings are property of Volume! Dance.

Parent/Guardian’s Signature _____________________________________ Date _________
Section One: Volume Dance Tuition Payment Options
I/We hereby authorize Volume Dance LLC to initiate monthly debit entries to my/our account listed below. Amount Due $____________ Beginning ______/________/______ and last payment Ending_______/_______/_______  PAYMENT IN FULL  CASH  CHECK CREDIT CARD

 ELECTRONIC FUND TRANSFER AUTHORIZATION  Please use account information on file  Checking  Savings Financial Institution ___________________________ City ___________ State_____ Name on Card (please print!) _________________________________________________________________________________ Routing/Transit Number ___________________________________ Account Number ___________________________________  CREDIT CARD PAYMENT AUTHORIZATION  Visa  Master Card  Discover

Name on Card (please print!) _________________________________________________________________________________ Credit Card Number _______________________________________________Exp Date ______________ Zip Code_________ Signature of Account Holder ________________________________ Date ____/____/_____ Signature of Joint Holder __________________________________ Date ____/____/_____

Section Two: Other Fee Payments
(Competition, costume, spirit gear, showcase, choreography, and any late and/or overdraft fees) Please choose a method of payment.  Please use the same card information that I chose for tuition auto payment. Initial _____  Please use the following method of payment:  Visa  Master Card  Discover  Check  Visa  Master Card Cash  Discover

 CREDIT CARD PAYMENT AUTHORIZATION

Name on Card (please print!) _________________________________________________________________________________ Credit Card Number _______________________________________________Exp Date ______________ Zip Code_________ Signature of Account Holder ________________________________ Date ____/____/_____ Signature of Joint Holder __________________________________ Date ____/____/_____

All fees are due at the first of the month as indicated on the payment schedule.

I/We acknowledge that the origination of electronic fund entries or credit card transactions as indicated above to my/our account(s) must comply with the provisions of U.S. law. I/we understand that (1) a monthly debit or charge will be made to my bank or credit card account on or after the 1st day of the month; (2) Volume! Dance LLC shall notify me/either of us of any changes in amount or date of payment before such a revision is made; and (3) if my/our bank information listed above changes for any reason, a new authorization form will be completed and submitted to Volume Dance promptly. This authorization shall remain in effect through the end of the current dance season or until Volume! Dance LLC has received a 30 day written notification from me indicating that my child, or myself, is withdrawing from classes and/or my desire to discontinue electronic fund authorization and credit card payment (initial) _____. The balance due must be delivered in cash directly to Volume! Dance LLC. In the event of insufficient funds, account holders will be charged a $35 REPROCESSING FEE in addition to their regular monthly tuition. A $10 late fee will be charged for payments received after the 15th of the month and every 30 days payment is past due. Fees are non refundable. Enclosed is $__________ covering 1st month’s tuition plus the $40 family registration fee. Signature
of Account Holder_______________________________________________Date ______/________/______

__________________________________________________________________________ ______

FOR ALL-STAR COMPETITION DANCERS ONLY I understand that I/or my child has been chosen as a member of the Volume Dance all-star team. As a member, I also understand and accept the terms of the 2009/2010 all-star dance team packet that was sent via email on 07/22/09. If a dancer drops, quits, or is removed from the squad, fees are non refundable. Signature of Parent/Guardian _______________________________________________________________ Signature of Dancer _______________________________________________________________________ Date __________

FOR OFFICE USE ONLY
Student #1 ________________________________ Class _____________________ Day/Time _________ Tuition $________ Class _____________________ Day/Time _________ Tuition $________ Class _____________________ Day/Time _________ Tuition $________ Student #2 ________________________________ Class _____________________ Day/Time _________ Tuition $________ Class _____________________ Day/Time _________ Tuition $________ Class _____________________ Day/Time _________ Tuition $________ Student #3 ________________________________ Class _____________________ Day/Time _________ Tuition $________ Class _____________________ Day/Time _________ Tuition $________ Class _____________________ Day/Time _________ Tuition $________ Regular Monthly Tuition without discounts $________ Discounts ____ All-Star Dance Team Family Discount ____ 40% off 2nd child ____ 3rd child free ____ Recreational class discounts ____ 2nd class $5 off ____3rd class or more $10 _____ Recreational sibling discount $5 off ____ classes =

Discounts -$_______ Discounts -$_______ Discounts -$_______ Regular Monthly Tuition $_______

Other School Dance Team(name)__________________

Day/Time _____________Number of Team Members X $15

Total $_______ Total $_______

Birthday Party (name) _________________________Date/Time _____________Number of guests ____

Registration Fee$_______ Total Amount Due Today $_________ Start Date _________ Staff Initials ________
Calculator: To prorate classes, divide the total monthly tuition by the total number of weeks in one month. Do NOT include the registration fee in the total amount of monthly tuition. Multiple the total by the number of weeks left in the month.

Other Adjustments:


				
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posted:11/28/2009
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