Registration Form-Fall

Registration Form for Fall/Spring

*Please read in FULL the Policies and Procedures before starting your registration process, by following the link at the bottom of this page. Thank you.*

Status: (*)

New Student
Returning Student

Student First Name: (*)

Student Last Name: (*)

Gender:

Female Male

Birthdate: (*)

Medical Considerations: (*)

Class, Day, and Age:
"SOME CLASSES MAY BE FULL" Please list your first class choice and then your second class choice if you are unsure. (*)

Time: (*)

Registration Fee (Non-Refundable upon cancellation): $50 (*)

Monthly Tuition (*)

Production Fee $90 Due October 5th ( If Participating ) (*)

Costume Fee - November 5th ( If Participating ) Based on number of costumes (*)

Address: (*)

City: (*)

Zip: (*)

Home Phone: (*)

Contact #1 (Name): (*)

Relationship: (*)

Cell Phone: (*)

E-mail (*)

Contact #2 (Name): (*)

Relationship:

Phone: (*)

How did you hear about us? (*)

"TYPE OF PAYMENT" (*)

Consent and Release: As student/ legal guardian of student named above, I give my permission for his/her involvement in activities, performances including off campus events of Dance Academy of Mansfield. Parents, legal guardians of minors, students and adult students waive the right to any legal action for any injury sustained on school property resulting from dance activity or any other activity conducted by students before, during, or after class time. I consent to the use of any video images, photography, and audio recording, or any visual or audio reproduction that may be taken of the student during any class or event.

I HAVE READ THE POLICIES AND PROCEDURES (BY CLICKING ON THE LINK AT THE BOTTOM OF THIS PAGE) FOR THE ACADEMY AND AGREE TO FOLLOW THEM.

I herby authorize Dance Academy of Mansfield to initiate recurring debit entries to my bank Account at the depository institution named and in the amount(s) and on the dates or days indicated.

*A $10 fee will be charged for ALL declined debit, credit, and automatic bank draft transactions. This includes expired expiration dates on credit cards. After the first declined transaction the fee will be $20 thereafter*

This is a confidential agreement between you and Dance Academy of Mansfield and will be secure. Your Monthly payment for tuition will on the first of every month. Costume and Production fees will be processed in October and November respectfully. (*)

Policies and Procedures

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Policies and Procedures

Studio Etiquette