Xtreme Dance Studio 2012 Summer Registration Form

Your signature on this registration form indicates your understanding and acceptance of these policies. Please mail or bring your registration form and non-refundable deposit of $35 to reserve your spot in camp/class at XTREME DANCE.

Students Name Parent/Legal Guardian Work Phone Address

DOB

Age

Sex

Home Phone: _______________________ Cell Phone:_____________________E-mail City Drive By Zip

How did you hear about Xtreme Dance Studio? Current Student Advertisement (which one) Friend Other

Emergency Contact Phone List any allergies or other health problems, including food allergies (asthma, knee problems, hearing/sight impairment, medications, foods, etc.) In the event of an emergency I, child. (Parent/Legal guardian signature)
Dancers Primary Health Care Doctor

give Xtreme Dance Studio permission to seek medical attention for my

Phone Number

Minimum camp/class size is 5 active students. Any less may result in a schedule change or cancellation.

Camp/Class: Camp/Class: Camp/Class:

Session: _______________________________ Session: _______________________________ Session: _______________________________

By signing this form, I hereby enroll as a member of XTREME Dance Studio and understand that he/she will be considered a member for the summer 2012 school session. I understand that I am responsible for complying with all school policies. I also fully understand the costs involved. LIABILITY WAIVER: Xtreme Dance Studio is not responsible for accident, injury to persons and loss or damage to their property, whether on the premises of the studio or off the premises, or in connection with your classes, training, rehearsals, performances, and travel to and from off premises, rehearsals and performances. It is required that all dance students are covered by their own family insurance policy. I acknowledge that there are risks of injury in participating in these activities and knowingly and freely assume all such risks and hereby release and hold harmless The Xtreme Dance Studio, its officers, agents, contractors, employees, owners, and /or owners and leasers of premises and equipment. Below indicates your understanding and acceptance of all policies and waiver on this form.

Parent Signature

Date

TUITION STANDARDS AND POLICIES 1.) Deposit: There is a non refundable $35.00 deposit due with your registration form. 2.) Tuition: The tuition balance is due prior to or on the first day of camp/class. If tuition is not paid in full prior to or on the first day of camp, the student may not participate. WE WILL NOT SEND A BILL. For your convenience you may mail in your tuition or call it in with a credit card. 3.) Returned Check: There will be a $35.00 fee for any returned checks and payment must be paid in cash or with a money order. 4.) Holidays, Vacation, Sick Days: Tuition is due regardless if absent; there are no refunds for missed days. 5.) Tuition rates: It is imperative to the operation of Xtreme Dance Studio that tuition and fees be paid on time. We appreciate your cooperation in these matters. Lets Dance Camp Ages 3-5 $125.00 or $30.00 per day Ballet Level 3/4 and 5/6 (twice a week for 4 weeks) $122.00 Music Video Camp $175.00 (DVD must be picked up by July 27th) Beginner Summer Dance Intensive $165.00 or $40 per day Intermediate/Advanced Summer Dance Intensive $325.00 ADVERTISING Photos, videos, film or audio recordings taken during XTREME studio events, become the property of XTREME Dance
Studio and reserves the right to use those items for marketing, publicity purposes. Your signature indicates your understanding and acceptance of this policy. Parent Signature For Office Use Only Registration Date : Deposit Paid: $____________date paid:_________ Payment Type: cash check credit Balance Due: $_______________ date paid: _________________ Payment Type: cash check credit

Staff Member Signature:_______________________________ Print: _________________________________