Student Registration
(Please Print)
Student's Name___________________________________________________Age________________________
Address______________________________________________________________________Zip____________
Name of Parents/Legal Guardians_______________________________________________________________
Home Phone_________________Work_______________________________Cell___________________
Date of Birth____________________________Eligible for 3, 5, or 10 year trophy?____________________
(for 3, 5, or 10 years of consecutive study at Academy of Dance Arts)
Emergency Contact (other than parent/legal guardian)
Name_____________________________________Phone______________________________
Relationship to student________________________________________________________
Please list persons who have permission to pick up student._________________________________________
Medical Conditions/Allergies_________________________________________________________________
Current Medications_______________________________________________________________________
Please List Any Other Information We Need To Know About Student_______________________________
__________________________________________________________________________________________
Previous Dance Experience___________________________________________________________________
How did you hear about us?__________________________________________________________________
Classes Enrolled___________________________________________________________________________
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Tuition Information Monthly____________________
Registration ($45)___________________________________________________________________________
Aug.________________________________________________________________________________
Sept.__________________________________________________________________________
Oct._________________________________________________________________________________
Nov._________________________________________________________________________________
Dec._________________________________________________________________________________
Jan._________________________________________________________________________________
Feb._________________________________________________________________________________
March_______________________________________________________________________________
April________________________________________________________________________________
Costume Fee(s) $70 ($65 Pre Ballet, Pre Tap, Mini Jazz, & Mini Tumbling) ___________________________________________________________________________________________
Recital Fee $30 _____________________________________________________________________________
**I have received a copy of the Academy of Dance Arts brochure. I have read and agree to the terms, conditions and specific information listed in the brochure.**
____________________________________________________ ___________________________________
Signature of parent/guardian Date