Form: 2008CDA Registration Form: 2008-2009
(please use a separate registration form for each student) )
Last Name of Student: _______________First Name of Student:__________________ Birthdate:________________ Grade:_______School:___________________________ MAILING Address: _________________________ City/Zip: _____________________ Home Phone:______________________ Email:________________@_____________ Mother’s Name: _______________________ Cell Phone:_______________________ Father’s Name: _______________________ Cell Phone:_______________________ Emergency Contact: ___________________ Phone:___________________________ Physician’s Name: __________________________Phone:______________________ Check the Class(es) You are Registering for:
_____ PRE-BALLET: Mon 3:30-4:30 _____ PRE-BALLET: Wed 4-5pm _____ BEG. BALLET: Mon 4:30-5:30 _____ BEG. BALLET: Wed 5-6pm _____ BALLET I: Thurs, 5pm – 6pm _____ ADULT DANCE: Mon 7-8pm
_____ BALLET II: Mon 6-7pm AND Thurs, 6pm – 7pm _____ PRE/POINTE: 5:30-6pm* _____ HIP HOP Wed 6-7pm _____ ADULT AEROBICS: Wed 7-8pm
*Teacher invitation only - Requires concurrent enrollment in Ballet II CLASS TUITION A $15 registration fee is required to hold your spot in any class(es). The registration is a flat fee – please pay only once, even if you’re enrolled in multiple classes. 1 hr. per wk: 2 hrs. per wk: 2.5 hrs per wk: 3 hrs. per wk: 3.5 hrs. per wk: $40 per mo. $78 per mo. $98 per mo. $118 per mo. $138 per mo.
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We offer a family discount (more than one student enrolled per family) of $2 off per month, per student. We also offer a $2 discount (per month) for Country Club members If you wish to pay for a year’s worth of tuition at one time, you will receive June’s tuition free (June 2009). To calculate a year’s worth of your student’s tuition, (less June), multiply their monthly rate by 9.
Payment for the month is due by the first of each month. A $10 late fee will be assessed for payments received after the 1st. Payments should be mailed to: Terah Partridge, Camano Dance Academy, 651 Dodge Road, Camano Island, WA, 98282. Payments can also be placed in a sealed envelope and placed in the tuition drop box during class. The first month’s payment plus the registration fee must be received prior to the first class. A $25.00 service fee will be charged for each check returned by the bank due to insufficient funds. CDA reserves the right to cancel classes when enrollment drops below five students. If a class is cancelled due to low enrollment, a refund will be given. Refunds will not be issued for missed classes. We do not issue credit for vacations. Students who miss a dance class due to illness may request to attend a similar class and make up their absence, if one is available. Ballet classes will generally follow the school calendar, and class will not be held on holidays. Calendars will be distributed at the beginning of the session. If I wish to discontinue classes at any time, a refund for the month’s remaining paid classes will be given, less a 20% cancellation fee. Please describe any medical situation which could limit the student’s activities, or any food allergies, etc.____________________________________________________ ___________________________________________________________________ By signing below, I approve of my or my child(ren)’s participation in dance classes presented by CDA. Upon my or my child(ren)’s acceptance into this program, I hereby for myself, my child, executors, administrators and assignees, waive and release any and all rights and claims for damages which may hereafter accrue to me which I may have against Terah Partridge, and any of her independent contractors, representatives, successors and assignees for any and all injuries, loss and damages suffered by me or my child(ren). I declare under penalty of perjury that the foregoing information is true and correct. SIGNATURE____________________________________________DATE__________ Relationship to Student: _____________________________________________________________________