Gotta Dance - Registration Form

Registration

	Please call to obtain tuition & class availability prior to mailing registration form.
	Correct payment must accompany registration form.
	Phone: 248-737-9400
	Mail completed Family Registration Form along with payment & both copies of Tuition Agreement/Waiver of Liability Form:
	Gotta Dance • 6381-D Orchard Lake Road • West Bloomfield, MI 48322

Family Registration Form 2010/2011

Last Name_________________________ Home Phone_________________________

Address________________________________________________________________ (Street) (City) (Zip)

Cell Phone ________________________ Work Phone__________________________

E-Mail__________________________________________________________________

Emergency Name________________________________________________________ (other than parent)

Emergency Phone_________________________________________________________

Student’s Name:___________Date of Birth____/____/____ Age/Grade Fall ______

Please list all classes by student first name below:

STUDENT	DANCE CLASS	DAY/TIME	% DISC.	MO. PMT	*MO. PMT x 2

TOTALS: *

Initial Payment: Total *MO. PMT x 2 $ _______________ + Family Registration Fee $25.00 = $ _______________

Monthly Payment = $ ______________

Mail 1) Registration Form 2) Tuition Agreement/Waiver of Liability Form (sign both sides, we will return your copy the first day of class)

3) Payment by check payable to: Gotta Dance. Address: Gotta Dance = 6381-D Orchard Lake Road = West Bloomfield, MI 48322

Office use only:

DATE: ________________ Check # ____________ REG. #_____________ DW: ___________ CC: _____________

TUITION AGREEMENT/WAIVER Of LIABILITY FORM

TUITION AGREEMENT AND WAIVER OF LIABILITY FORM

I fully understand and agree to the policy and terms of Gotta Dance, LLC.

I understand that:

¶ There are no adjustments or refunds for missed classes.

¶ No refunds unless you cancel two weeks prior to start of class.

¶ Registration fee, hold fee and last month’s tuition payment are non-refundable.

¶ Tuition is based on nine equal payments due on the first of each month.

¶ First and last payment due at registration.

¶ A 20% late charge will be applied to overdue accounts.

¶ Please make checks payable to: GOTTA DANCE

¶ There is a $25.00 fee for returned checks due to insufficient funds plus additional bank fee.

¶ 5% discount for tuition paid in full by cash/check at time of registration (restrictions apply)

¶ Sibling & multiple class discounts available (some restrictions apply)

¶ Tuition statements will not be mailed. Payment is expected on the 1^st of each month.

¶ In the event of inclement weather, Please call the studio for prerecorded cancellation notice. There are no make-ups for cancelled classes due to inclement weather.

¶ I give Gotta Dance, LLC permission to use my child’s dance pictures for promotional purposes.

¶ Failure to comply with any of the above or any of our etiquette guidelines will result in immediate dismissal from the program.

¶ Please refer to calendar posted inside the studio and on our web site for scheduled vacation and holiday closures. Web address: www.igottadance.com

Dance student acknowledges, agrees and understands that dance training can be hazardous to some individuals and may result in injury to dance student or other dance students. Dance student agrees that in consideration for permission to enter onto the premises of Gotta Dance, Dance student assumes all risks of injury incurred or suffered while on and/or upon the premises of Gotta Dance, and releases and agrees not to sue Gotta Dance, its agents, servants, associations, employees or anyone connected with Gotta Dance for any claim, damages, costs or cause of action which Dance student has or may have in the future as a result of injuries or damages sustained or incurred while on and/or upon the premises of Gotta Dance.

_________________________________________Relation ___________________

Parent Name (Print) (if under 18 years of age)

_________________________________________ Date__________________

(Signature)

MONTHLY PAYMENT = $__________________

èCopy of Tuition Agreement and Waiver of Liability Form Provided by: _________

GOTTA DANCE, LLC l 6381-D Orchard Lake Road l West Bloomfield, MI 48322

www.igottadance.com l 248-737-9400 l gottadancemail@aol.com

CUSTOMER COPY