Kick 2010-2011
Registration Form
Name: ________________________________
DOB: _____________
Parents Name: ________________________________
Address:
Cell Phone: _________________ Phone: _____________
E-mail: __________________________
Which Class (es) are you
registering for? (Please select classes carefully,
transfers may not be available)
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STUDIO |
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Please select: Full year Fall only
Class
Fee in full: ____________________
5
Payment option: ___________ Fall only 2 payment option: ____________
Registration
Fee: $35
Costume
Payment ($65 before 11/1, $75 after 11/1) _______________
Total
Due: _______________
Current
Payment: _________
New
Students only How did you hear about Kick?
I understand that
dance is an inherently risky activity and I agree to hold harmless, Kick, Vanessa
Berry, and any other instructor at Kick for any bodily injury sustained while
participating in any class or performance associated with Kick. I also
understand that all payments are final and refunds and make up classes are not
offered. Payments are due at time of registration, 9/15 and for a full year
11/1, 1/1 and 3/1. Final payment is due 3/1/11. I have read the 2010-2011 Dance
Brochure and I am familiar with the required dress codes for dance classes,
(check with Vanessa BEFORE you purchase shoes!). Information is sent via email
and posted on the website, kickstudio.com. Pleas alert Kick if you are not
receiving monthly emails. Kick has an open door observation policy; however
parents are strongly encouraged to limit observation to the last five minutes
of class.
Parent/Guardian
Signature: Date:
Fair
www.kickstudio.com