2017 Summer Registration
Student First Name
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Student Last Name
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Student's Date of Birth
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Student's Email
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Mother's Name (if student is under 18)
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Mother's Number (if student is under 18)
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Father's Name (if student is under 18)
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Father's Number (if student is under 18)
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Main Email Address
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Emergency Contact
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Emergency Contact Phone #
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Street Address
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City
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Zip Code
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Academic School Student Attends
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Grade
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Please list any allergies, medications, behavioral issues, etc.
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Previous Dance Training
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Which session are you registering for?
Which age range are you registering for?
If you are registering for an evening class, which one are you registering for?
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How did you hear about Wilmington Conservatory of Fine Arts?
Disclaimer
I am aware that dance training and athletic exercises associated with it place unusual stress on the body and carry the risk of physical injury. On behalf of my child and myself. I assume the risk and agree that Dance Arts Con-servatory and its facilities shall not be liable in any way for injuries sustained during attendance at the school or any of its related functions. I also understand that good dance training involves touching and adjustion of the stu-dent’s body by the instructor.Agree
Photo Release
I hereby give permission for images of my child, captured during regular and special WCFA classes and events through video, photo, digital camera to be used solely for the purposes of WCFA promotional material and publications and waive any rights of compensation or ownership there to Wilmington Conservatory of Fine Arts.
Medical Release
In the event I cannot be reached, I hereby give my permission to the management , faculty, staff and chaperones of Wilmington Conservatory of Fine Arts to authorize any emergency medical care that my be required by the above student dur-ing participation classes, performances, or any related WCFA events. This authorization extends throughout the current academic year and throughout the summer or until the student is no longer enrolled at WCFA, whichever comes first. I understand that I am responsible for any and all charges as a result of such medical treatment.
Tuition Payment Agreement
I agree to pay WCFA for the dance instruction of the above student per the published tuition rates for the student’s period of study. I understand that I can make payment by check or money order payable to Wilmington Conservatory of Fine Arts. There will be a $30.00 charge for returned checks. I understand that no refunds will be given for classes missed because of illness, vacation, or school closings due to acts of na-ture such as inclement weather. I understand that tuition fees are due on the first of the month or on date agreed upon in payment plan; that if payment has not been received within 5 business days a Late Fee of $10.00 will be assessed.
Withdrawal Policy
I understand that I must turn in a withdrawal slip as a 30 day notice or my account will be charged a full months tuition. Withdrawal slips are available upon request.
Person responsible for payment
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Relationship to student
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How are you paying today?
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