2017-2018 Registration Form

October 2, 2017 - June 9, 2018

Preschool | Youth Dance    Ages 18m-18y


975-C Grand Ave - St Paul, MN 55105 | 651.224.8951 |hello@spectrumdancemn.com | dancespectrum.com

ALL STUDENTS, NEW AND RETURNING, MUST BE ENROLLED BY DECEMBER 16, 2017*.

Complete all information on this form and return with proper payment.  Registrations are accepted in the order received.  Full tuition is due with completed Registration Form or Installment Agreement. *A Late enrollment fee will be incurred post Dec 16, 2017

STUDENT 1 NAME

DOB

             /            /

 MM                   DD              YR

STUDENT 2 NAME

DOB

             /            /

 MM                   DD              YR

STUDENT 3 NAME

DOB

             /            /

 MM                   DD              YR

PARENT 1 NAME

Phone

Address

City

Zip Code

E-mail

please print clearly

SEPARATE NOTICE:  Notices are sent to "Parent 1." Check this box to send separate notices to Parent 1 and Parent 2.

PARENT 2 NAME

Phone

Address

City

Zip Code

E-mail

please print clearly

EMERGENCY CONTACT

In the event that Parent 1 or Parent 2 can not be reached, please contact the following:

Name

Phone

Relationship to child

ADDITIONAL INFORMATION

Name of Child's School

Grade

How did you hear about Dance Spectrum?

Returning Student      Friend      Publication      Online      Other:

Print any medical conditions or allergies that Dance Spectrum should be made aware.

Dance Spectrum is not authorized to administer medications. Consult with Director regarding serious medical issues.  If necessary, First Aid procedures may be applied.

I am the legal parent of the student/s named in this Registration Form and authorize for enrollment of my children to attend and participate in Dance Spectrum classes and activities have read and will comply with Dance Spectrum Policies/Guidelines and Tuition Agreements. I understand and agree that Dance Spectrum, its agents, contractors, volunteers, or assigns shall not be responsible or made subject to any claim from injury or accident which may result in connection with any participation at Dance Spectrum or any of its related function.

X __________________________________________________________________________________       ______________________________

   PARENT SIGNATURE                                                                                                                                                       DATE

PLEASE SEE REVERSE FOR CLASS SELECTIONS AND TUITION INFORMATION ⇨ ⇨ ⇨ ⇨ ⇨ ⇨ ⇨ ⇨ ⇨ ⇨ ⇨ ⇨


Student 1 Name:

CLASS NAME (as it appears on the schedule)

DAY OF

TIME

CLASS LENGTH

Total Weekly Class Hours:

(See Tuition Schedule for Tuition Installment rate) - Tuition Installment:

$

Total School Year Tuition (LINE 1):

For classes scheduled October 2, 2017 through June 9, 2018 [Tuition Installment amount X 9*]

$

Student 2 Name:

CLASS NAME (as it appears on the schedule)

DAY

TIME

CLASS LENGTH

Total Weekly Class Hours:

(See Tuition Schedule for Tuition Installment rate) - Tuition Installment:

$

SIBLING DISCOUNT 10%

-$

Total School Year Tuition (LINE 2):

For classes scheduled October 2, 2017 through June 9, 2018 [Tuition Installment amount X 9*]

$

Student 3 Name:

CLASS NAME (as it appears on the schedule)

DAY

TIME

CLASS LENGTH

Total Weekly Class Hours:

(See Tuition Schedule for Tuition Installment rate) - Tuition Installment:

$

SIBLING DISCOUNT 10%

-$

Total School Year Tuition (LINE 3):

For classes scheduled October 2, 2017 through June 9, 2018 [Tuition Installment amount X 9*]

$

Student 1 - TOTAL SCHOOL YEAR TUITION

LINE 1

$

Student 2 - TOTAL SCHOOL YEAR TUITION

LINE 2

$

Student 3 - TOTAL SCHOOL YEAR TUITION

LINE 3

$

P L E A S E   S E L E C T   Y O U R   O P T I O N   F O R   T U I T I O N   P A Y M E N T   B E L O W

  I will pay for the TOTAL SCHOOL YEAR TUITION

October 2, 2017 through June 9, 2018 [Add LINES 1~3] - TOTAL SCHOOL YEAR TUITION DUE:

$

 Valid October 2, 2017-August 9, 2018 - Single Student $25/ Family $40 - REGISTRATION FEE:

$

10% off- School year Tuition paid in full (no installments)

-$

GRAND TOTAL

$

 ☐  I will pay in TUITION INSTALLMENTS

[Total School Year Tuition Due (Add LINES 1~3)  ÷ 9 Installments*] - TUITION INSTALLMENT DUE: 

$

 Valid October 2, 2017-August 9, 2018 - Single Student $25/ Family $40 - REGISTRATION FEE:

$

GRAND TOTAL

$

Full school year  tuition is due upon enrollment. Installment Option: 9  Installments are due, October 2017 through June 2018 for Youth Enrollment

1st of each month, October 2017 through June 2018 (July 2018 for Company members*).

* Performing Company Tuition is broken into 10 Installments and valid for regularly scheduled classes August 28, 2017 through August 9, 2018.

CREDIT or DEBIT CARD - VISA OR MASTERCARD ONLY

NAME ON CARD

CARD NUMBER

EXPIRATION DATE MM/YY

3 DIGIT SEC #

BILLING ADDRESS

CARDHOLDER SIGNATURE

X

ALL REGISTRANTS MUST COMPLETE A SEPARATE CREDIT CARD ON FILE FORM; RETURN CCOF WITH THIS REGISTRATION.          9/17