Address

City State Zip

Telephone # Email

Mother's/Guardian's Name

Work Phone # Cell

Father's Name

Work Phone # Cell

Student's Birthday Age

School Attending

Medical Information

Physician Phone #

Medical Conditions

Classes

Class 1 Day Time

Class 2 Day Time

Class 3 Day Time

Class 4 Day Time

Policy Agreement

I have read all the policies of the Louise School of Dancing. I understand and will adhere to all of the terms and conditions.

Parent (Guardian) Name

Date

Payment

New Student: 1 class per week: $45.00/month (multiple student/class discounts available)

To guarantee a place in class, each student must fill out and return a Registration Form with a Non-Refundable Tuition Payment of 2 months (based on amount according to how many classes are taken weekly) plus the Registration fee of $25 per family.
This is based on a seasonal tuition, not the number of classes each month. The payments are the same each month in order to eliminate confusion.
For first year pre-school students, the last month tuition will be refunded if the Studio feels the child is not ready by the 4th lesson.

Total to reserve classes (Registration fee plus 1 month of class fees)

Make checks payable to "Louise School of Dance

*The rest of the Registration Fee will be settled on the first day of class.*