Gotta Dance - Registration Form

Registration

	Please call to obtain tuition & class availability prior to mailing/faxing registration form.
	Correct payment must accompany registration form.
	Phone: 248-737-9400

FAMILY REGISTRATION FORM

Phone: 248-737-9400

Last Name:________________________ Home Phone:________________________

Address________________________________________________________________

(Street) (City) (Zip)

Cell Phone_______________ Work Phone______________

E-Mail_________________________________________________________________

Emergency Name & Phone_______________________________________________

(other than parent)

Student’s Name:___________Date of Birth____/____/____ Age/Grade Fall ‘07______

(first)

Student’s Name:___________Date of Birth____/____/____ Age/Grade Fall ‘07______

Please list all classes by student first name below:

Student Name of Class Day & Time Tuition

______________________________________________________________________

INITIAL PAYMENT:

Please indicate method of payment: Registration Fee: $25.00 (per family)

Make Checks Payable to: Gotta Dance Total:______________________

Balance:_____________________

Check (number) ___________ Visa______ MasterCard_____Billing Zip Code________

($25.00 fee for returned checks) (zip code for credit card only)

Cardholders Name_______________________________________________________

(print)

Account Number ________________________________________Exp. Date________

(acct. #'s do not remain on file, for automatic tuition payment you must complete Authorization Form provided at Gotta Dance)

Signature _________________________________________________Date _________

TUITION AGREEMENT AND WAIVER OF LIABILITY FORM

Mission Statement:

A favorable attitude, a willingness to practice, good attendance and parental support are key factors for accomplishment in our school. A majority of our dancers will choose not to become professional, still we feel it is very necessary that they receive the highest standard of quality in training, for their Gotta Dance experience will always enhance whatever vocation they follow.

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 and last months tuition payment is non-refundable.
	Tuition in based on nine equal payments and due the first of each month.
	A 20% late charge will be applied to overdue accounts.
	There is a $25.00 fee for returned checks due to insufficient funds plus additional bank fee.
	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)

Complete form in person at Gotta Dance, Fax 248-671-5350 or

Mail Form to:

Gotta Dance

6381-D Orchard Lake Road

West Bloomfield, MI 48322

(correct payment must accompany form, please call 248-737-9400)

OFFICE USE ONLY:

Reg. #___________