Registration Form 2007/2008 Season

Parent Name:__________________________________________________________________

Address:____________________________Town:_____________________Zip:_____________

Home Ph____________________Cell Ph:______________________Work Ph:_______________

Email:________________________________________________________________________

Emergency Contact:____________________________Ph:_______________________________

Student Name:____________________________ DOB:___________ Years at Dancenter:_____

Student Name:____________________________ DOB:___________ Years at Dancenter:_____

Student Name:____________________________ DOB:___________ Years at Dancenter:_____

Class/Day/Time:___________________________ Class/Day/Time: _______________________

Class/Day/Time:___________________________ Class/Day/Time: _______________________                

Class/Day/Time:___________________________ Class/Day/Time: _______________________

Class/Day/Time:___________________________ Class/Day/Time: _______________________

  Stoneham Dancenter                                          North Reading Dancenter

PAYMENT METHOD

                   Please mail my quarterly bill to the above address.

                   Please e-mail my quarterly bill.

                   Please automatically charge my credit card when quarterly payments are due, including     

           costume payments.

      VISA      MC      #:_________-_________-_________-_________      Exp:_____/_____

Signature of Card Holder:_________________________________________________________

First Quarter Tuition along with the Registration Fee is due at time of registration.

RELEASE FROM LIABILITY: I do hereby release Susan Woods’ Dancenters and anyone employed by Susan Woods’ Dancenters from any liability occurring on or around the studio premises, or at any function held at other locations in connection with dance classes in which the student(s) named above is/are enrolled.

POLICIES AND PROCEUDRES: I have read and agree to all of Susan Woods’ Dancenters policies and procedures and I also give Susan Woods’ Dancenters the right to use photographs of my child in dance class or from recital pictures in the future for advertising or on the website.

 __________________________________       __________________

                   (signature)                                          (date)

How did you hear about us?________________________________________