DeGrasse Dance Studio Registration Packet

Page 1: Prices - your copy

Page 2  : Registration & Tuition Payment Agreement – Please fill out , sign , date & turn in


Page 3 : Agreement continued –your copy        

Page 4: Agreement continued- Please fill out , sign ,  date & turn in

Page 5: Waiver- Please fill out ,  sign , date & turn in 

Page 6: Payment Schedule –  sign , date &  turn in -Keep a copy

Page 7: Confirmation of enrolled classes  - please sign, date  & turn in

Page -1-Prices

Ballet + other dance -Package Plans

Annual Registration Fee


Monthly Tuition

**see tuition discounts

Creative movement



Package Plan 1- 1 ballet  per week



Package Plan 2 - 2 ballet  per week


                                  -1 ballet + 1 other



Package Plan 3 - 2 ballet +1 per week


                                    1 ballet +2 other



Package Plan 4 - 4 ballet per week

                                    (2 ballet 2 pointe)


                                     2 ballet + 2 other




Package Plan 5  - 4 ballet +1 per week


                                     2 ballet +3 other



Package Plan 6 - 4 ballet +2 per week


Package Plan 6+- 4 ballet + 3 other  =7  





8 +Unlimited



Recreational Plan –Tap/Hip hop

(no ballet included)

Annual Registration Fee


Monthly Tuition

1 class per week



2 classes per week



Performance fees-nonrefundable

A performance fee will be charged to EVERY family for the December and June performances. This fee covers rehearsals , choreography, stage rental etc.  

See payment schedule for due date

Costume Fees nonrefundable

A costume servicing & rental fee  per costume will be charged.  Costumes must be returned to the studio after use .

**Tuition Discounts

The Nutcracker Performance fee $100 per family

Not included in package plans

Tickets must be purchased for all performances

Summer Performance Fee $100

The Nutcracker  -$45 per costume

Summer performance - $45 per costume

$15 off sibling registration

15% off sibling tuition

Full 11 month payment→ 3% off

Page - 2                                DeGrasse Dance Studio

                Registration & Tuition Payment Agreement 2016– 2017



Student’s Full Name  __________________________________________        __        

Student’s DOB  _____________________________________AGE___

Parent(s) or Guardian(s)____________________________________________

Street Address ___________________________________________________

City__________________________ State___________  Zip  ______________

Parent’s Place of Employment_______________________________________  

Home Phone ____________________    Work Phone____________________

Cell Phone ____________________________

Emergency Contact Name  _________________________________________

Emergency Contact Phone  _________________________________________

Email (Primary)  _________________________________________

Email (Secondary)  _______________________________________




Parent/Guardian Signature                                                                          date



Page – 3                        DeGrasse Dance Studio

Registration & Tuition Payment Agreement 2016-2017


Tuition Payment Agreement:


Payment Policy

All payments will be charged to your Visa or MasterCard, or debited from your checking account. All payments are due the 1st of the month. If you wish to pay the entire year’s tuition in full, email Dianne Auburn at  and a 3% discount will be applied to your tuition.


One of the two Authorization Forms below MUST be filled out and signed:


*Form #1: Automatic withdrawal from your Visa or MasterCard or Debit




*Form #2: Automatic withdrawal from your checking account authorization.

(MUST include a voided check)


Drop Out Policy:

DeGrasse Dance Studio requires 30 days written notice (1 month) if you choose to drop out of classes. (For example, if you drop out during any point of a month, but have not given advance notice, you will be required to pay for that month’s tuition.) We are unable to give refunds. (We will of course make exceptions if there has been an injury of some sort, supported by a physician’s note.) We have limits on the numbers of students if a class is full… therefore, if someone drops out abruptly, we are unable to refund that month’s tuition.

All written notices to withdraw must be emailed to Dianne Auburn: 


Questions concerning your account should be directed to:

Dianne Auburn at: 


Page – 4                        DeGrasse Dance Studio

Registration & Tuition Payment Agreement 2016-2017



Authorization Form #1


I understand that my credit card will be charged the 1st of each month for my tuition payment and any annual registration fee due. I authorize DeGrasse Dance Studio to use the Visa, MasterCard, Visa Debit Card, or MasterCard Debit card number below beginning the month of: _____________________________.


Name On Credit Card  ______________________________________________

Student’s Name  __________________________________________________

Credit Card Number ________________________ Exp Date  ______code______


-   OR   -


Authorization Form #2 –


I understand that my checking account will be debited the 1st of each month for my tuition payment and my annual registration fee due.

I authorize DeGrasse Dance Studio to use the account number below beginning the month of: ____________________.



Name On Account  _______________________________________________

Student’s Name  _________________________________________________

Signature  _______________________________________Date____________

Please provide voided check


            DeGrasse Dance Studio Waiver Form

My child ( or children) , enrolled at DeGrasse Dance Studio ,  have my permission to participate in the scheduled activities. I understand that I will not hold DeGrasse Dance Studio , or it’s instructors responsible for any injury’s that may occur while on the premises , during , before , or after scheduled activities.

Student Name (please print)

Student Name (please print)

Student Name (please print)

                                                                                        /         /

Parent Signature                                                                        date

If there are any health issues, please specify:

Page -6-Sign , date & Keep a copy for your records

 De Grasse Dance Studio , Inc.

 Payment Schedule Agreement

Payment schedule includes registration fees , monthly tuition , and miscellaneous fees you may or may not incur.

*Miscellaneous fees include :

        * Service fees for costumes:  $45 per costume- additional charges  may occur  depending on costume

        * Performance fees:   $100 per family

        * Tickets for all performances will have to be purchased.

* If enrolled in Competition : $130 due the 1st of each month  plus incurred private rehearsals,costumes  &  choreography fees.

*Required Leotards for ballet students only>>see order form page 8

* Special Note: Students enrolling in or after the month of February , having just paid the registration fee for the current season , will not be expected to pay the next season’s registration fee , until July 1st , if enrolling.

Payment Schedule for Enrolled Students:

July 1 , 2016        Registration fees due  for season 2016-17

August 1                Tuition payment  due

                Competition  monthly fee  ($130) due if student began  competition work in August

September 1        Tuition due

Competition  monthly fee $130 due

October         1        Tuition due

Competition  monthly fee  $130 due

October  15        Nutcracker performance fee $100  due (per family) plus costume fees $45 per student

November 1        Tuition due

Competition  monthly fee  $130 due

Dec ember 1        Tuition due

Competition  monthly fee  $130 due

January 1, 2016         Tuition due

Competition  monthly fee  $1130 due

February  1        Tuition due

Competition  monthly fee  $130 due

March 1                Tuition due

Competition  monthly fee  $130 due

April 1                Tuition due

Competition  monthly fee  $130 due

April 15                June Performance fee $100 due (per family) plus costume fees $45 per student

May 1                Tuition due

Competition  monthly fee  $130 due

May 15                Registration due for 2017-2018 season

June 1                        Tuition due  ( last payment for 2016-17 season)

Competition  monthly fee  $130 due (last monthly payment for 2016-17 season)

July 1                Registration fees due  for season 2017-18

August 1                Tuition due for August 2017 if enrolled

*Print name below & sign by X at bottom

I  ______________________________________have read , and understand the monthly payment schedule, and will abide by this schedule. I understand that my account will be charged any penalty fees incurred by the bank , for insufficient funds. A late fee of $35.00 will be charged to my account if payment is not made within 5 days of the due date each month. If I decide to withdraw  my child or a sibling , of a child still enrolled , from  DDS , I must give 30 days written notice ,  via email  to Dianne Auburn (  ). Sending an email to anyone else , including Johnna DeGrasse  ,will not stop charges on my  account. If sending an email to Johnna DeGrasse I MUST  SEND A COPY to Dianne Auburn.


Signature (person responsible for payment )                                Date

Page – 7

DeGrasse Dance Studio  -   Fall 2016-2017

Confirmation  of Enrolled Weekly Classes  

Name student:______________________________________________________________________________        

(please print  & fill out 1 form for each sibling)

creative movement

# classes per week___


 (include pointe classes)

# classes per week___


# classes per week___


# classes per week___


# classes per week___

Hip hop

# classes per week___


# classes per week___

Other specify:

# classes per week___

Total # classes per week___

Recreational students



hip hop

Total weekly classes__

Registration amount

$________          previously paid amount $______

 monthly tuition amount


 full season amount

$_______ 3% discount____

Competition team only

 monthly competition fee


My total monthly charges are


I__________________________________________________ acknowledge that the above information  

(name parent or person responsible for payment)print                                

is correct . informing Dianne Auburn in writing at ,  If the number of enrolled classes taken  by my child , or children , changes , at any time throughout the season, I will update class information, by turning in this form (page 7) . I will be responsible for any tuition due , and understand DDS will not be held responsible for refunds if not  given written notice, of any drop of classes. I understand that there are no refunds for absences.  


Page 8

Attention all registered ballet students Only:

This is your Order Form for the required color Leotard according to student level.

The top 3 levels (Juniors on up) will be required to wear the skirts as well. No more shorts in ballet class please.

Please turn your forms in a.s.a.p..Orders can take up to 3 weeks.

 Make Checks payable to Liesl Dancewear not DDS please.You may drop your orders in an envelope in the hallway mailbox or leave them with me at the desk.

thank you


Order Form

Liesl Dancewear

13885 Hedgewood Drive #141, Woodbridge, VA 22193

(571) 659-2937

Name (Child)________________________________Age____________


o   Creative movement – Pink (TC0053C) -$28.62

o   Pre-Ballet – Lt. Blue (BWP025) -$23.32

o   Beginners 7/8 y.o. – Lilac (BWP025) -$23.32

o   Intermediate 8/9 y.o. – Turquoise (BWP025) -$23.32

o   Intermediate 10/13 y.o. – Wine (BWP025) -$23.32

o   Juniors – Violet (BWP025) -$23.32, Wrap Skirt (10362) - Lilac - $18.00 --- Total - $41.32

o   Apprentice B – Royal Blue (CC202) -$27.56, Wrap Skirt (10362) - Royal Blue - $18.00 -- Total - $45.56

o   Apprentice A – Burgundy (CC202) -$27.56, Wrap Skirt (10362) - Burgundy - $18.00 -- Total - $45.56




o   T _______

o   S________

o   I ________

o   M _______

o   L ________

o   XL _______


o   XS _______

o   S ________

o   M _______

o   L ________

o   XL _______



Name (Parent)_________________________________________________________________ Phone_Number________________________________________________________________ Email________________________________________________________________________ Total_____________________Check_#_(Make check payable to Liesl Dancewear)__________ CC #_________________________________________________________________________ Exp. Date__________________________CVC___________Billing Zip Code________________

*Prices include tax.