Premiere Dance Registration Form

Premiere Dance Registration Form

Student Name:

Address:

Phone: Home

Cell:

Parent(s) Name(s):

Emergency Number:

Email:

Signature of Student:

Signature of Parent or Guardian:

Date:

Class(es) for Enrollment-include day & time so we may check availability of open spots:

Registration Fee:

I release and discharge Premiere Dance and its employees and affiliates from all liability arising out of, or in connection with, participation in rehearsals, shows and promotional events. I also give my permission to use my photo and/or name on the dance studio website and for any advertising. I understand tuition is due the 1st of the month and there is a $12 charge for late payment. There will be a $25 fee for bounced checks. Unpaid accounts will be processed by a collection agency. I also realize there are no refunds on tuition, registration or costume fees. A 30 day written notice is required if I no longer choose to attend classes.

Students under 18 should not submit a registration form without a parent or guardian's permission. CA residents only.

Submit the registration form to info@premiere-dance.com.

Registration payment can be made at the studio prior to your first class (Visa, MasterCard, Discover, cash, money order or check) when you submit the form. We also take credit cards over the phone.

Classes filled on a first come, first serve basis.