Enrollment Form Date
Dancer’s Name
Date of Birth Age Grade
Address(es)
Parent/Guardian
(If under 18 years of age)
Phone #’s
Email address(es)
Dance Interests
Previous/Current dance training
Comments/Trial class scheduled
How did you hear about us?
Medical conditions, medications or restrictions
(All information will be held confidential)
Emergency Contact/Phone #’s
I, the above-named dancer, or the parent or guardian of the above-named dancer, understand that Dance is a hazardous activity from which all risk of injury cannot be eliminated. I consent to the above-named dancer’s participation in The Ballet & Dance Center’s activities and I assume the risks incidental to the participation in such activities.
Signature of adult dancer/parent/guardian:
_____________________________________________ Date
Call 446-6600 or email
3470 Erie Blvd. East, P.O. Box 375, Dewitt, NY 13214
Enrollment Form – Page two Date
Dancer’s Name:
Please enroll me for the following 2009/2010 class(es):
Class Name & Level/Day/Time Class Name & Level/Day/Time
1. 6._______________________________
2. 7. _______________________________
3.__________________________ 8. _______________________________
4. 9. _______________________________
5. 10.
Classes Annual Tuition Classes Annual Tuition
Per Week Tuition Installment Per Week Tuition Installment
Creative Movement 360 36.00 Five Classes 1,450 145.00
One classes 375 37.50 Six classes 1,625 162.50
Primary with Tap 555 55.50 Seven classes 1,775 177.50
Two classes 720 72.00 Eight classes 1,900 190.00
Three classes 975 97.50 Nine classes 2,000 200.00
Four classes 1,225 122.50 *No additional tuition due if enrolling in more than nine classes
Annual Payment Plan
Total number of classes per week ____________
Total annual tuition ____________
Less advance payment, 5% ____________
Less family discount, 5% ____________
Plus enrollment fee (non-refundable) $15.00
Total due at time of enrollment ____________
Installment Payment Plan
Total number of classes per week __________
Tuition installment ____________
Two tuition installments due at enrollment ____________
Less family discount, 5% ____________
Plus enrollment fee (non-refundable) $15.00
Total due at time of enrollment ____________
#____Installments due 1st of each month ____________
I agree to be responsible for all the tuition installments of the above mentioned student. I understand that enrollment is for the entire 2009/2010 dance year and that I will pay all tuition associated with that year. I must give The Ballet & Dance Center two months notice of withdrawal and I am liable for the tuition due for that two month period.
Signature Date_________________________
Call 446-6600 or email kfalcone@TheBalletAndDanceCenter.com
3470 Erie Blvd. East, P.O. Box 375, Dewitt, NY 13214
