STUDENT REGISTRATION FORM

*Registration not complete without $50 registration fee and signature(s) on back

Student Name

Date of Birth

Any Medical issues?

Parent or Legal Guardian _________________________________ Home phone _____________

Address __________________________ City _________________ State _______ Zip ________

Work phone _______________ Alternate phone ___________________ E-mail _______________________________

Name	Class	Day/Time/Location	*Duration (in hrs)
		Total Hours per week =
* Leave blank if on open plan. Do not include open plan hours in family total.

Standard scale tuition : $ _______ Open tuition = ____ dancers x $_______each = $_________

Standard tuition + Open tuition = $ _________ total tuition

Payment schedule: ☐ in full $ _______ ☐ in 2 installments of $________ each

☐ in 8 installments of $________ each

*Payment may be made in cash or by check (payable to Applause! Applause! Performing Arts Center).*

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New students:

How did you hear about us? ___________________________________________________________

If you have prior dance experience, where? ____________________________________________

I have received and read the policies of Applause! Applause! Performing Arts Center. I recognize that regular class attendance is important for student progress and that it is my responsibility to attend all classes. I also understand that failure to attend the lessons does not relieve me of my obligation to pay tuition; two weeks written notice will be required for withdrawal from class(es) for which I have registered. If written notice is not given and I stop attending class, I will be billed for the remainder of the session tuition. I also understand that all tuition and fees are non-refundable and non-transferable.

While Applause! Applause! Performing Arts Center is committed to conducting its programs and activities with the safety and well-being of its students in mind, I recognize that participation in any of these programs or activities involves some risk of injury. I certify that I am able to participate in any program or activity with Applause! Applause! Performing Arts Center. I further understand and agree on behalf of myself, my heirs and assigns, that Applause! Applause! Performing Arts Center, its directors, officers, staff, instructors, volunteers, landlords or lessors and AARAA/Rince NoVa, in whole or in part, are not responsible for any and all illness, injury, or damage that I may suffer as a result of my participation in any of Applause! Applause! Performing Arts Center’s classes, rehearsals, performances, and related programs or events.

Dancers may be photographed as participants in school photo day or any other school classes/events.

_____ Yes, I give Applause Applause Performing Arts Center permission for my/my child’s photo to be used for school promotion or studio decoration. I understand that NO last names/personal information will be used in conjunction with any photos.

_____ No, I do not wish to have any individual photograph of me/ my child placed on the Applause Applause Performing Arts Center website or used in any promotional marketing for Applause Applause Performing Arts Center at this time.

____________________________________________ __________________________________________

student signature                                date           parent signature                                 date