Center Stage Registration Form

Student’s Last Name_________________________________ First Name: _________________________________

Date of Birth_____________ Age ______ Grade __________ School Attending___________________________

Person Responsible for paying Tuition_________________  DOB____________  SSN#___________________

Mailing Address_____________________________________________________________________

    City _____________________________________    Zip ________________

Home Phone _______________________________    Cell Phone_____________________________

Mother’s Name ________________________________    Father’s Name______________________________

    Workplace ___________________________        Workplace________________________

    Work Phone__________________________        Work Phone______________________

Parent’s email address _______________________________________________________________

Emergency Contact ______________________________________    Phone______________________

Does the student have any physical conditions or limitations the instructors should be aware of?

    Yes ________    No______    If so, please explain____________________________________________

Previous Years Training & Where____________________________________________________________________

How many years taken at Center Stage_______________________________________________________________

Classes wanted: Ballet ___    Tap___     Jazz ___     Clogging___     Hip Hop___     Pointe___    

    Pre Ballet___     Baton___     Lyrical___     Company____    Pilates____    Acro____

How did you hear about us? ____ Newspaper _____ Word-of-mouth  ____ Phone book

______ Other (if this, how?)________________________________________________________

I HAVE READ, understand and agree to abide by the policies of Center Stage Dance.  I am agreeing to be responsible for all payments due.  I, the undersigned, accept the fee charged as a legal and lawful debt and agree to pay said fee, including any/all costs of collection,(33.33%), attorney fees and/or court costs, if such be necessary.  I wave now and forever my rights of exemption under the laws of the constitution of the State of Alabama and any other states. I, the undersigned, give Center Stage, its employees and/or agents “express prior consent” to contact me at any/all phone numbers, including cell phone numbers (by phone call or text message), for the purpose of payment.  Tuition is payable on or before the 1st of each month.  If tuition is not paid by the 10th, a late fee of $10 will be charged to your account.  Once enrolled, you have reserved a class slot.  This slot is yours whether you attend class or not.  You are therefore responsible for tuition whether you attend or not.  I understand that written notification is required prior to the month of withdrawal and tuition will be billed, including late fees, until written notice is received by the office.  Make-up classes will be given (if class space allows) to students who inform us in advance of an absence.  Make-ups must be scheduled within 30 days of the absence.  I understand that in any movement educational class, there are risks that could involve injury.  I release Center Stage and its instructors form any liability in case of accidental injury.  I allow the staff to take emergency medical action in case of injury.  I hereby release, indemnify and hold harmless C. G. Dance Studio, Inc. doing business as Center Stage Dance Studio and any of their employees or representatives from any and all liability or claims however arising.

Parent/ Guardian Signature________________________________________Date________________

    Please sign, date, and include your $25 registration fee to reserve your place in the school.

Class sizes are limited and will be filled in the order registrations are received.