Registration Form

Please choose one:

Registration Form 2011-2012

Please fill out the entire form and click on submit.

Online registration must be accompanied with a Paypal payment.

Contact/Student Info
Student:
Age/Grade:
Birthdate:
Parent:
Home Phone:
Cell Phone:
Street Address:
City/State/Zip:
Email:
Emergency Contact:
Phone:
Relationship To Student:
Medical Conditions/Allergies:
Class Information
Class Description:
Day/Time:
Class Description:
Day/Time:
Class Description:
Day/Time:
Class Description:
Day/Time:
Total Tuition Including Registration Fee:
Total Paid Today:
Balance Due:
Please Initial Each Of The Following:
After 1 month of registration, class enrollment can no longer be changed:
After 1 month of registration there are no refunds or credits:
Once a student is signed up for a class, he/she is responsible for the full year’s payment, as we hold a place for the student for the entire year:
Students may not participate in class if they do not adhere to our mandatory dress code:
All students are expected to be on time for class. Students more than ten minutes late will not be allowed to participate in class:
Any returned checks will be charged a $25 fee:
Please Date And Initial The Following:
Release from Liability: I do hereby Easton Dance Academy and its staff from liability occurring on or around the studio premises, or any function held at other locations in connection with dance classes in which student(s) named above is/are enrolled. I declare that the student(s) named above is/are in good health and can participate in dance education classes. Given the nature of dance classes, and with the knowledge that injuries sometimes might occur, I have taken the necessary steps to obtain accident, health, or hospitalization insurance which would cover any sustained injury. In the event of an injury or emergency when I cannot be contacted, I give my permission for you to obtain medical services for the student(s) named above.:

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