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Student
Name:_____________________________________________________
Mother's Name:____________________________________________________
Father's Name:_____________________________________________________
Student Address:___________________________________________________
City:_____________________________State:________ Zip Code:___________
Home #: (______)_______-___________ Cell #: (______)_______-____________
Mother's Work #: (______)______-______Cell #: (______)_______-___________
Mother's E-mail Address: ____________________________________________
Father's Work #: (______)_______-________ Cell #: (_____) ______-_________
Father's E-mail Address: ____________________________________________
Student Age:________ Date of Birth:________________________ Sex:______
School Attending:______________________________________ Grade: _____
Emergency Contact (other than above): Phone #: (______)_______-________
Name:____________________________________________________________
Relation to student:_________________________________________________
Address:__________________________________________________________
Family Physician_______________________ Phone #: (_____)______-_______
Classes- Please list all classes student will attend:
Class
1:___________________________________________________________
Class 2:___________________________________________________________
Class 3:___________________________________________________________
Class 4:___________________________________________________________
Class 5:___________________________________________________________
The annual, non-refundable registration
fee and first month's tuition are due at enrollment.
Annual Registration
fee:
Tuition: |
$___________
Check/Cash/Credit: ____________
$___________ Date: ________________ |
Total: |
$___________ Parent's Initials: _______ |
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Name on
Credit Card: _______________________________________________
Type of
Card: ___Visa ___Master Card
Credit
Card #:______________________________________ Exp Date:_______
3 digit code on back of card _____
By signing
this waiver, you release SHOWTIME Dance and Performing Arts Theatre
and all of its employees from all claims related to any injury which
may be sustained by you or your child while attending any of our classes,
or events associated with SHOWTME Dance and Performing Arts Theatre. You also affirm
that you currently have and will continue to carry proper medical, health,
hospitalization, and accident insurance, which you consider adequate
for you or your child.
Tuition
is paid monthly. Sorry, there can be no refunds for pre-paid missed
classes, however, we will be happy to accommodate you in accordance
with our make-up policy.
Student's
or Parent's Signature_____________________________________________
Date:_______
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