Registration

Registration Application

First Name: Last Name

Address:

City: State: Zip:

Home Phone:

Date of Birth: Age: Current School:

In case of an emergency, please notify:

Name: Number:

Occupation/Business:

Mother:

Father:

Select the programs you wish to register for. Student placement is based on age, ability, and experience requests are not a guarantee of placement.

Please enter in your Experience (if any)

How did you hear of Mrs. P's Dance & Acrobatic Studios, Inc.?

Medical Limitations: (if yes, please explain. If no, type "none")

I Understand

That tuition is to be paid on the 1st of every month.
That I will be responsible for the full monthly tuition regardless of my child's attendance.
That no refunds or credits will be given for classes missed, or not attended.
That the school reserves the right to alter class schedules, for any reason either temporarily or permanently, without fault.
That an interest rate of 1.5% per month will be charged on all charges in arrears for 30 days or more and a tuition late fee will be assessed for tuition not received by the 10th of the month. That I will be responsible for all legal and collection fees incurred by the school should my account become delinquent.
That my child will be refused admittance to class if tuition payment is not made by the second class of the month.
That my child will be required to participate in the year end recital program.
A) That the auditorium is closed to viewing during rehearsal
A) That for my first recital fee I will receive 2 {two} tickets to recital, class picture in program, 1 {one} costume, participation in rehearsals and recital

B) For additional recital fees I will receive 1{one} ticket to recital 1 {one} costume class picture in program and participation in rehearsals and recital no video is included in additional recital fees
That these recital fees will be refundable up to the recital fee due date (November 17, 2007). Should I, for any reason, not be able to continue my child in the school after this date, these fees will not be refunded to me, nor will I be entitled to any benefits listed in 8 A) above.
That my child will be participating in a physical activity. And as such, I realize there is an element of physical risk involved.
That any limitation in ability to participate due to any medical conditions past or present must be noted on this form.
That I will not hold the school responsible for any injury or situation arising from any injury either directly or indirectly.
That in the event of an accident, I will be notified first. If the school is unsuccessful in contacting me, they will call a person I have designated for emergency situations. In the event neither of us can be reached, I grant the school to act as guardian for my child and administer whatever first-aid is required.
That all medical expenses incurred will be at my own expense.
That all recordings included but not limited to video, audio, still picture, motion pictures of any event including but not limited to recitals, rehearsals, dance acts, classes, demonstrations, remain the property of the school with all rights of ownership retained by the school.
That the school reserves the right to drop registrant from their roster for: a) Excessive lateness and/or absence, b) Disruptive behavior, c) Non-payment of tuition or other charges.
That in the event of any dispute between the school and myself, I agree to pay all expenses, including but not limited to legal fees and court costs, incurred by the school.
That all late fees will be a minimum of $10.00 or 1.5%, whichever is greater.
That all monies, including final months tuition are due prior to receiving tickets {including complimentary tickets} for recital.

There is a one time registration fee of $40.00 per child and this fee is non-refundable. Please complete the below credit card form.

Name of card holder as it appears on the card:

Credit Card Number: CVV# (What is this?)

Credit Card Type:

Expiration Date: / Registration Fee: $ 40.00

In submitting this form you agree that you have read the above policies and fully understand them. I also authorize Mrs. P's of Boca Raton to process the registration fee to my credit card.

Please enter your email address:

(If you don't have email please type "none")