FALL 2021-2022 REGISTRATION FORM
42-16 28th Avenue 2nd Floor, Astoria, NY 11103 718.278.1567
Submit one registration form per child.
Are you a New Student or Returning Student?
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Student's First and Last Name: *
Date of Birth: *
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Age: *
Parent's Name: *
Cell Phone #: *
Secondary Phone #: *
Address: *
Street and Apartment #, City, State, Zip Code
Parent Email Address: *
Student Email Address:
How Many Years has your child completed at ADC:
How Many Years has your child completed at another dance school:
How did you hear about Astoria Dance Centre: *
Class Options (Choose one): *
Fall Classes for ages 3-5
Fall Classes for ages 5-7
STUDENTS IN THE GEMSTONE GROUPS/LEVELS BELOW ARE PLACED IN CLASSES ACCORDING TO THEIR AGE AND DANCE EXPERIENCE.
Fall classes - Gemstone Levels for ages 8 & up
PERFORMANCE TEAM - BY AUDITION ONLY
Fall Classes for ages 9 & up
Does your child take any prescription medication regularly? *
If yes, please describe:
Are there any Medical, learning or behavioral conditions that Astoria Dance Centre should know about?
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If yes, please describe:
Check the boxes below once you have read them: *
Required
You will receive an email with your Paypal invoice to pay your non-refundable registration fee. Registration Fees - $40.00 per student. $55.00 per family.
Going forward, for your future installment fees, will you be paying by (Choose one): *
We will email you the payment form to fill out and send back to us.
Tuition Payment options (Choose one): *
$72.00 for one 45 minute class. $80.00 for one 1 hour class. $100.00 for one 75 minute class. $120.00 for one 90 minute class.
Electronic Signature or Parent/Guardian if student is under 18: *
Today's Date: *
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*SCHEDULE IS SUBJECT TO CHANGE OR CANCELLATION PENDING ENROLLMENT.
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