Billing Name and Address_______________________________________________________________________

(if different)

Registration

Registration fee of $25 is due at time of registration and is non-refundable.

Student Name_____________________________________________________

Birthdate__________________ School_______________________ Grade______

Address___________________________________________________Apt. #______________

City__________________________Zip_______________Hm. Ph.(______)______________

Parent Email Address____________________________________________________________

Mother's Name_________________________________Wk. Ph.(______)________________

Occupation__________________________________________________________

TDL # _______________________ SS # __________________________ Cell # (______)________________

Father's Name__________________________________Wk. Ph.(_____)_________________

Occupation__________________________________________________________

TDL # _______________________ SS # __________________________ Cell # (_____)_________________

Has student ever danced before? Yes No If Yes, Name of Studio and How Many Years______________________________

How did you hear about us _________________________________________ / Referred By_____________________________________

Please list Day & Time of class/classes if enrolled here last year.

1.________________________________2._______________________________3.___________________________________

Classes Desired: 3 & 4 year olds___ Ballet/Tap (combo)_____ Ballet____ Tap____ Jazz___(must take ballet)

(ballet, tap & tumbling) Mom & Me___ Hip Hop ____ Tumbling ___Pre-Pointe___ Pointe____ Other____

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Office Use Only

Class___________________ Time__________________ Class_________________Time________________

Class___________________ Time__________________ Class_________________Time________________

Class___________________ Time__________________ Class_________________Time________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Rachal Dance Studio Policy

Please read carefully as registration constitutes an understanding and acceptance of these and any other policies.

1. The Registration Fee is not refundable. Please no bills over $50 for Payment of Fees. Coupons are subject to terms and conditions.

2. All tuition payments are due on the 1^st of each month. After the 10^th of the month a $20.00 late fee will be due.

3. If you decide to drop class/classes, you must complete a Drop Class Request 30 days BEFORE the next months tuition is due,.

If you drop, Any outstanding balance must be paid. Over Due Accounts will be charged a $15 processing fee and sent to a Collection Agency.

4. If you fail to inform us of your desire to drop, you are still responsible for any charges that may accrue on your account.

We are not aware of any personal situations that may be going on. You may contact in person, by phone, or e-mail.

5. There will be a $35.00 returned check charge and a $10.00 reprocessing fee per check.

6. There is no reduction in tuition for missed lessons, holidays or dropped classes; no extra charge for 5- week months.

7. A minimum enrollment is required for a class to be scheduled. Refunds are subject to an office fee.

8. Recommended dance attire is black leotard, theatrical pink tights, pink ballet shoes; black tap shoes (NO ribbons or bows).

9. Rachal Dance Studio is not responsible for lost or stolen articles. All items must be labelled and placed in a tote bag.

10. Rachal Dance Studio may add or change any policy. I understand that by taking dance an injury can occur.

I have read and understand the above Rachal Dance Studio policies, and received the Rules, Procedures and Policies packet,

(init)_______ and agree to follow them and to attend for the entire school year in which I (or child) enrolled. My signature

allows for the use of photographs, voice, and/or video of my child for Public Relations purposes. I also understand that dance has certain

inherent risks and include, but are not limited to, sprains, bruises, pulled muscles, and broken bones.

Therefore I will not hold Rachal Dance Studio, Inc. liable.

______________________________________________ _____________________________ ____________________

parent signature date employee initials