Registration - 2009-10 School Year

Classes begin Monday, August 17th, 2009
All Classes are Open Enrollment (you can begin anytime during the year)
and Ongoing (until you discontinue)

Student Name:

Date of Birth:

Age:

Address:

City:

State: Zip:

Home Phone:

Cell Phone:

Parent(s) / Guardian Name:

Parent(s) / Guardian Email:

Which class(es) are you interested in?

What dance experience has your child had?

If your child has any health problems or learning disabilities we need to be aware of, please explain below.

How would you like to pay your tuition? (Tuition Policies)

Pay monthly by Electronic Funds Transfer (EFT Authorization Form)
Pay by semester with check or cash
Pay monthly by cash or check (Add'l Fee)
Pay quarterly by cash or check (Add'l Fee)

Note: If you wish to pay by EFT, please print and complete the EFT Authorization Form, and return it to:

955 Hawkridge Ct
Eaton, CO 80615

as soon as possible.

How did you hear about A Dance Place?

By checking this box, I have read and agree to the studio policies.

1292 Main Street #5
Windsor, CO

206 Oak #2
Eaton, CO

Phone: (970) 590-9530 • Email: farrah@adanceplace.com