Registration Form

Student Name

Birth Date (MM/DD/YY)

Age

Address

Phone Number

Cell Phone Number

Email Address

Emergency Contact Full Name

Relationship

Phone

Class Requested 1 Class Requested 1 Class Requested 1

I | 1. Class Day | 2. Day of the Week | 3. Class Time

Class Requested 2 Class Requested 2 Class Requested 2

II | 1. Class Day | 2. Day of the Week | 3. Class Time

Class Requested 3 Class Requested 3 Class Requested 3

III | 1. Class Day | 2. Day of the Week | 3. Class Time

Method of Payment Method of Payment Option A Option B Option C

Parent who authorized this registration

9 + 10 =

Fees for 2017-2018 Season

45 Minute Class …………………………………………… $56/ month

60 Minute Class …………………………………………… $64/ month

90 Minute Class …………………………………………… $80/ month

Individual students and families who take 4 or more classes are entitled to a 10% discount on monthly tuition.

PAYMENT OPTIONS

OPTION A

Full Payment upon registration (5% discount)

OPTION B

50% of tuition due at registration and 50% due on February 1st, 2018

OPTION C

Payments will be automatically deducted on the 1st of each month from a credit card on file.
Final Payment will be charged for May/ June on May 1st, 2018.

** If you opt not to pay by automatic billing , there will be a $25 late fee if tuition is not paid by the 15th of the month.

** There is a $20 service charge for returned checks or declined credit card payments.

**In the event that a Parent withdraws the Student from the Studio, the Parent MUST give notice to the Studio, either in written form or by telephone.

F.YI.

All classes are subject to change.
Suggested arrival time is 5 minutes prior to start of dance class.
Dance shoes are not to be worn outside.
Dance clothes are to be worn at all times.
For the safety of our students , please do not double park outside the dance studio.

First month’s tuition plus $40 insurance fee is due at the time of registration.
Please make checks payable to Magnolia Dance Academy. Don’t forget to include your $40 insurance fee. Thank you.