Registration Forms



                                                                                                                                                                                                                                                                                                                FALL 2018
         PK’s School of Dance Class Registration 
   **Please bring this form completed to registration (one form per student)

Student Name:                                                             
Parents Name:                                                             
Address:                                                                    
Age:                       Date of Birth:                             
Home Phone: (    )                                                        
Cell Phone: (     )                                                          
Parent’s email:                                                             
Emergency Name & Phone:                                               
School:                                                  Grade:             
***New Students Only**
Please put amount of years taken beside each subject listed:
· Pre-School Combo           · Tap             · Ballet               · Pointe                · Jazz              · Acrobatics            · Baton              · Hawaiian              · Hip Hop                 · Contemporary              · Lyrical                         
 List any other type of dance & amount of years:                                                                                                                                                                                                                                * Age requirements: ·Pre-School Dance (ages 3-5) ·Jr/Sr. Combo (ages 5-9) Tap, Ballet, Acrobatic, Baton & Jazz (ages 6 & up) ·Hip Hop (ages 8 & up or age 7 with 1 year of training in jazz) Hawaiian/Tahitian (ages 8 & up or age 7 with 2 years training in any dance subject)
     Which class or classes are you interested in taking this year? (Please check)
            ·Pre-School/Combo                                    ·Tap
            ·Junior/Sr. Combo                                   Ballet/Lyrical                  
            ·Pointe (teacher rec.)                                    ·Acrobatics
            ·Jazz/Modern                                        ·Baton                
            ·Turns Leaps Progressions (TLP)                        ·Hip Hop

            ·Contemporary            
Have you had any training at another dance school other than PK’s School of dance? YES or NO
If YES, what dancing school did you attend?                                                 

What subjects did you take & print the number of years you took beside each subject?                                                                                                                                                                                                           
                                                                                                                                                                                                   





Release from Liability and Payment Terms

We, the undersigned parents and/or legal guardians of ________________________________________________,
a minor, upon signing this agreement do herby acknowledge that the activities that I have requested my daughter/son participate in may be stressful on the body and carry with them the risk of physical injury. On behalf of my child and her/his parents and/or legal guardians, I assume the risk and agree that PK’s School of Dance, Pam Franz, Karen Trivus, instructors, assistants, or staff shall not be liable in any way for any injuries sustained or loss of property during attendance at the dance studio of any of its related functions.

My child has permission to receive any necessary emergency medical care. Students must be covered by their own family health insurance. It is understood that the student’s own health insurance policy will be the only source for payment for any medical services, out of pocket expenses, and pain and suffering that may be incurred or result for treatment due to the injury.

Monthly Tuition Payments:
I understand that the tuition for dance classes is due by the 10th of each month. The tuition is based upon the total number of scheduled classes for the dance year, and is not based on the actual classes during any given month. The tuition payments are evenly spread over the year and will remain the same regardless of the number of scheduled classes that month .I understand the tuition is nonrefundable and there is a $5 late fee if tuition is not received by the 10th of each month.

Those who are paying by our “Bi-Yearly/ 2 payments p/ year” plan, will pay ½ of their total tuition at registration or on their child’s first day of class, and their balance is due no later than January 15th, . This plan will save you between 10-15% off your total cost per payment. Students enrolled after September 30th, must pay monthly.

**N.S.F. Checks will be charged a $25 service fee. We accept tuition payments made by cash or checks only. Checks are payable to: PK’s School of Dance.

Child’s Name:  ___________________________________

Parent’s Name:  __________________________________

Parent/Guardian Signature                                                                                                                        

Date                                                      

Best contact # for each guardian:                                                                                                              

Emergency contact (other than mom/dad):                                                                                               

Relationship to student & Phone Number                                                            (      )                           

Medical Insurance Provider                                                                                                                      

ID/Policy #                                                                                                                                                

Family Physician                                                                           Phone # (    )                                      

Any issues your child has that we should be aware of?  _____________________________________

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