Grand Jetè Dance Academy
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Grand Jetè Dance Academy
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Grand Jeté Dance Academy Dance Registration 2009-2010 Date Today ______________ New Student _____ Current Student _____ How did you hear about us ____________________________________________________ Student Name: _________________________________ ___ Birth Date __________ Address: _______________________________________________________________ City: ______________ State: ____________________ zip: _______________________ Name (Mother/ Guardian): ______________________ Phone: ____________________ Work Phone: _________________________________Cell Phone: _______________ Name (Father/ Guardian): ______________________ Phone: ___________________ Work Phone: _________________________________Cell Phone: ________________ Adult Student's Phone: ______________Work Phone: _____________Cell Phone: ___________ Emergency Contact: __________________________ Phone: ___________________ E-Mail address: ______________________________________________________ If you or your dancer has any medical condition of which we should be aware, please indicate below. Also say what you would like the studio staff to do in the event of a medical emergency. ___________________________________________________________________________________ Please turn the page over, initial the payment option and sign the medical release. 1. _____________________ 2. _____________________ 3. _____________________ 4. _____________________ 5. _____________________ 6. _____________________ 7. _____________________ 8. _____________________ Registration Fee: $15 (new)______ $10 (Returning)______ Payment Plan: Annual Quarterly Installments Class Card Method of Payment: Cash Check _____/______ Credit Card Reg. Fee: ___________ Tuition: ____________ Retail: _____________ Total:_____________
Registration/Release Form I understand that tuition is not based on single monthly lessons, the academic year covers 38 weeks of which there are 35 weeks of instruction and 4 weeks of holiday. Allowance is made for the 4 weeks of holiday which is included in the full amount. In other words: those months that have 5 weeks of instruction make-up for those that have only two weeks of instruction. Make up classes may be taken during the instruction week, but all make-up classes are forfeit upon withdrawal. I agree to give 1 month paid notice in writing should I, or my dancer, wish to withdraw from classes. I choose to honor my annual tuition commitment in the following manner: 1.) One annual payment at a 10% discount (5% if done by credit card). _____________ 2.) Quarterly payments due September 1, December 1, and March 1. ______________ 3.) Nine installments due the 1st. of each month, September through May. __________ 4.) Class Card, adults only. _____________ In consideration of being accepted as a student of Grand Jeté Dance Academy, LLC, I hereby certify that I do not suffer from any physical infirmity or illness which would affect my ability to engage in Dance Activities other than stipulated on this side of this agreement and I agree as follows: To forever Release and Discharge Beth and Jim Gilleece of Grand Jeté Dance Academy, LLC, their families, assigns, agents and employees, (herein collectively referred to as Released Parties) from any and all liability, claims, demands or causes of action that I may hereafter have from injuries and damages arising from my willing participation in Dance Activities, including, but not limited to, losses caused by the negligence of the released parties. I understand and acknowledge that dance activities have inherent dangers that no amount of care, caution, instruction or expertise can eliminate and I Expressly and Voluntarily Assume ALL Risk of Personal Injury Sustained While Participating in Dance Activities. I have carefully read this agreement and release liability, I fully understand its contents, and sign it of my own free will. Signature: ________________________________ Date: ______________________ ---------------------------------------------------------------------------------------------------------------------- Release of Minor: I certify that I am the parent or legal guardian of the above named minor participant, that I have read, understand and consent to the foregoing AGREEMENT AND RELEASE OF LIABILITY on behalf of the above named minor participant. Signature of Parent:_________________________ Date: ______________________ Signature of Guardian:_______________________ Date: ______________________ For a printable copy of this form please click here |
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Send mail to jim@grandjeteda.com with
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