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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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.
Costumes
for our year end production in June are $75 each. Rates are per family. Payment
plans are available for families enrolled in two or more classes per week.
Payment due dates are 9/15, 10/1, 12/1, 2/1, and 3/1. Fall session must be paid
in full no later than October 15, 2010, while full year must be paid in full by
4/1/2011. Sessional fees are not refundable or transferable. A credit may be
offered in cases of extended illness or injury. Make-up classes are not
offered. For More Information (732) 212 1322
Parent/Guardian Signature: Date:
Fair
www.kickstudio.com