FALL REGISTRATION FORM/AUTOMATIC PAYMENT CONSENT 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 #: *
Home Phone #: *
Address: *
Street and Apartment #, City, State, Zip Code
Email: *
Student Email:
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:
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Class Options (Choose one): *
Classes: *
List the classes you would like to enroll your child in below. You can refer to the Fall Schedule on our studio website: www.astoriadancecentre.com/schedule/ Please include the Day and Class Name.
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: *
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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): *
$71.00 for one 45 minute class. $79.00 for one 1 hour class. $99.00 for one 75 minute class. $118.00 for one 90 minute class.
Electronic Signature or Parent/Guardian if student is under 18: *
Today's Date: *
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We would like to invite you to join our private Facebook group page so you can receive daily updates and news about the studio. Please provide your Facebook name below so we can invite you to join.
*SCHEDULE IS SUBJECT TO CHANGE OR CANCELLATION PENDING ENROLLMENT.
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