Inovice Statement of Account - PDF

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					              Dance Centre of the Hamptons & Manorville
               70 Old Riverhead Road Westhampton Beach, NY 11978 631-288-8594
                460 County Road 111 Suite 21 Manorville, NY 11949 631-395-8594
                             REGISTRATION 2010/2011
TODAY’S DATE:______________________                                                (CIRCLE STUDIO) WHB MV

STUDENT INFORMATION:
Name________________________________________________________________               Parent/Guardian______________
Address__________________________________________________________________________Zip Code______________
Home Phone___________________________                  (Circle) Cell or Work Phone _____________________________
Any medical conditions__________________________________________________________________________________
Student’s age as of 9/10_________________      Date of Birth____________________         Grade__________________
As of today, how many past years have you been dancing at Dance Centre?_____________________________________
REGISTRATION FEE & TUITION RATES:
The registration fee for 2010-2011 will remain at $20 per family.
Monthly Rates: 45 minutes classes = $50 (Twinkle Toes);
Classes of 60 minutes classes = $55, subsequent 45-60 minutes classes = $49 each.
Classes of 75 and 90 minutes = $65. Tuition for students taking 6 classes per week will be capped at $265/mo.
TUITION PAYMENTS:
Tuition calculations: Tuition is based on the period from September to June, and then divided by 10 to determine
the monthly amount. This calculation takes onto account that some months have greater or fewer classes due to
holidays. Tuition is due the first class of each month. A $10 late fee will be added as of the 15th of the month (NO
EXCEPTIONS). May and June’s tuition is due by 5/1/2011. If a class is added or dropped the proper form must be
completed in the office. If not you will be charged for the class until we receive the drop out form. You may take
an alternate class to make up an absence; however tuition credit won’t be given.
COSTUMES
November’s invoice will include a non-refundable $50 costume deposit per class. February’s invoice will include the
balance for each costume.
If you would like us to charge your credit card each month, a statement will be emailed to you.
We   accept   MC,   VISA    –   AMEX     -   DISCOVER#      __________________________________________________
EXP___________
CLASSES PREFERRED:
DAY                TIME                              CLASS               TEACHER                      AMOUNT
1.______________________________________________________________________________________________________
2.______________________________________________________________________________________________________
3.______________________________________________________________________________________________________
4.______________________________________________________________________________________________________
5.______________________________________________________________________________________________________
                                                                              MONTHLY TUITION_____________
                                                                              REGISTRATION FEE______$20____
                                                                              TOTAL           _____________



___________________________________________                              ______________________________________
PARENT/GUARDIAN SIGNATURE                                                      EMAIL ADDRESS
OFFICE USE ONLY
DATE PAID_________________CK#/CC/C_________________________AMOUNT_________________
XL LISTS_____________ATTEND LISTS___________COMPUTER INFO___________INOVICE_________

				
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Description: Inovice Statement of Account document sample