Offering Quality Dance Education in a Supportive Learning Environment
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:
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 $10 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. Student must come to his/her first class within one month of registration or the form will be discarded.
Registration payment can be made at the studio at your first class (Visa, MC, Discover, cash or check) or through Paypal (aprilmason2003@hotmail.com) when you submit the form. Payment must be made prior to student begining class.
Premiere Dance 10851 Olson Dr. Rancho Cordova, CA 95670
