The Elsa Pardo Dance Center
*2010-2011 Class Registration Form*
PLEASE PRINT CLEARLY
***Primary Email: ________________________________
Years that dancer(s) has been at EPDC __________
DATE: ____________
STUDENTS LAST NAME: __________________________FIRST: ____________________
(SECOND CHILD) LAST NAME: ____________________ FIRST: ____________________
(THIRD CHILD) LAST NAME: ______________________ FIRST: ____________________
LEGAL GUARDIAN(S): ___ Both Mother & Father ___ Mother ___ Father ___ Other
Parent or Guardian(s) Name(s):__________________________________________________
ADDRESS: ___________________________________________________________________
CITY/STATE: ____________ ZIP: _________ SCHOOL: ____________________________
B-Day (1st child) __________ AGE: _____ B-Day (2nd child) _________ AGE: _____ B-Day(3rd child) __________ AGE: _______
TELEPHONE #’S: HOME: ____________________FATHER’S CELL____________ MOTHER’S WORK: ____________FATHER’S WORK:_______________
STUDENT CELL: ___________________
*IN CASE OF EMERGENCY – Contact Information:*
NAME: _________________________ NUMBER: _______________ RELATIONSHIP: ____________
*PREVIOUS TRAINING:*
# OF YEARS: ______ STUDIO(S): _____________________________________
REGISTRATION FEE: __________
MONTHLY TUITION: __________
TOTAL AMOUNT DUE: __________ PAID BY: CASH: _____ CHECK #: _____ CHARGE______
SIGNED UP FOR AUTOMATIC PAYMENT? Yes____ No_____ (attach paper to this form)
I HEREBY ACKNOWLEDGE IN CONSIDERATION OF MY CHILD’S PARTICIPATION IN THE ELSA PARDO DANCE CENTER’S PROGRAM THAT ELSA PARDO, THE “ELSA PARDO DANCE CENTER” & ITS INSTRUCTORS WILL NOT BE HELD LIABLE FOR ANY INJURIES SUSTAINED ON THE STUDIO PREMISES. FURTHERMORE I HEREBY WAIVE AND RELEASE ANY CLAIMS FOR DAMAGES INCLUDING ANY INJURIES TO MY CHILD RESULTING FROM ANY ACT OR FAILURE TO ACT BY EPDC AND ITS REPRESENTATIVES.
I GIVE PERMISSION FOR MY CHILD TO BE PHOTOGRAPHED AND VIDEOTAPED DURING THE RECITAL AND FOR EPDC PROMOTIONAL PURPOSES. ALL RIGHTS ARE RETAINED BY EPDC.
___________________________________________ ___________
FOR OFFICE USE ONLY
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Please initial the following statements ensuring that you know and understand each of them. I understand EPDC’s purpose therefore,
1- I understand that registration fee, recital fee, tuition, and costume fees are non-refundable.
____________
2- We do not let students wait for parents outside the building. Students must wait inside lobby for parents to arrive.
____________
3- Statements are not mailed unless tuition is past due. I know that if my tuition is not paid by the 10th of the month, a $10.00 late fee will be added.
____________
4- Children are not allowed to run around the lobby (especially 3-5 year olds) They must stay by the parents side at all the times.
____________
5- I have read all regulations and will abide by them.
_________________________________________ __________
SIGNATURE OF PARENT/LEGAL GUARDIAN DATE
2010-2011 Calendar
