DANCE PLUS ENROLLMENT APPLICATION

2824 Thousand Oaks   *   San Antonio, Texas  78232   *   (210) 496-1687 

I, the undersigned, hereby make application for my child’s acceptance into classes at Dance Plus, Inc. and understand that a $40.00 non-refundable registration fee must accompany this application.  If accepted, I understand that my child will be expected to attend dance classes for the entire semester designated below.  I understand payment for said semester must be paid in full and will not be refunded in whole or in part once my child has been enrolled regardless of the extent of participation in the class(es).  As a condition of acceptance in dance classes, I covenant and agree to hold Dance Plus, Inc. harmless and forever indemnify it, its owners and its agents from any and all liability arising from injuries which my child should sustain while on the premises occupied by the school.  Upon re-enrollment in subsequent dance classes, I understand and agree that the conditions above will be applicable to such re-enrollment and binding on me without the necessity of completing an additional enrollment application.    *** PLEASE PRINT ***

Student Name  ______________________________________   Date of Birth ____/____/_____   Age _______

Grade ____   School ______________________  Previous Dance Instruction  _________________________

Student Address ___________________________________________   City ___________   Zip  ___________

Home Phone Number __________________________   Cell Phone Number  __________________________

Email Address: ______________________________________________

Billing Address (only if different from above)  _____________________________________________________

Bills to be sent to: (check one)   Mother: _____  Father: _____  Student: ____  Other/Name:  ______________

Student lives with: (check one)   Both parents: ____  Mother: ___  Father: ___    Other/Name:  _____________

Mother’s Name _______________________________________   Tx. Drivers License # __________________

Mother’s Place of Employment ___________________________ Work Phone Number _________________

Father’s Name _______________________________________   Tx. Drivers License # __________________

Father’s Place of Employment ___________________________ Work Phone Number _________________

Physician * REQUIRED *  _________________________________   Phone Number ____________________

Medical Problems ___________________________________________________________________________

Emergency Contact (other than parent) ____________________________________   Phone # ____________

I have received a copy of the Studio Policies and Rules and agree to abide by the terms and those above.

Parent/Student Signature  ____________________________________________  Date  ______________

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - OFFICE USE ONLY - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

             Semester  ____________________   Date of Trial Class _____________________     T-shirt _______

Class 1  ___________________________   Level ____   Day __________  Time _________________________

Class 2  ___________________________   Level ____   Day __________  Time _________________________

Class 3  ___________________________   Level ____   Day __________  Time _________________________

REG $______    TUITION:  ____ WKS @ $____/WK = $_________ ¸ _______ = $_________/month