DANCE TOGETHER FOR 2 OR 3 YEAR OLDS REGISTRATION FORM 2022-2023

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42-16 28th Avenue 2nd Floor, Astoria, NY 11103 718.278.1567

Registration fee and tuition payment must accompany this registration form.

Today's Date:

YYYY

Are you a New Student or Returning Student?

New Student

Returning Student

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Date of Birth: *

YYYY

Age: *

Student's First and Last Name: *

Parent/Guardian Name: *

Mailing Address: *

Street and Apartment #, City, State, Zip Code

Home Phone #: *

Cell Phone #: *

Email Address Required: *

Previous Experience? If yes, please list:

How did you hear about Astoria Dance Centre:

Mailing

Internet

Phonebook

Word of Mouth

Social Media

Ads

Other:

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Please list here any medical conditions or disabilities we should know about:

DANCE TOGETHER SESSION IV - SATURDAYS IS OFFICIALLY CLOSED AS OF 3/15/23

Dance Together Session Calendar - Session IV

Session IV Wednesdays - Begins April 26th and Ends May 31st

Session IV - Saturdays - Begins April 22nd and Ends June 10th

Select your day and time for our Dance Together Class *

Non-refundable registration fee $20.00 per student. Class Tuition Fee: $120.00

Session IV - Wednesdays 3:15 PM to 4:00 PM - Start date: 4/26/23

Required

You will receive a phone call from ADC to pay your non-refundable registration fee and the class tuition fee within 72 hours of registration.

Please read and check the box below: *

I have read and I agree to the Dance Together studio policies and guidelines. I understand that Astoria Dance Center, its employees and staff will be held harmless from any liability or claims resulting from my child's or my participation in this program. I assume all risks in the event of accident or injury to property or person(s) resulting in any activity. I agree that I will not hold the studio, faculty, staff, students or their families responsible for any sickness or viruses contracted while participating in classes or while visiting the studio. I also understand and I will not hold Astoria Dance Centre responsible for loss of personal items. I am aware that Astoria Dance Center may take photographs of its dancers for use in promotion of the studio. If I disagree with this, I have attached a letter stating so to this registration form. By signing below I agree to follow all of the above conditions and those included in the studio guideline handouts.

Required

Electronic Signature or Parent/Guardian if student is under 18: *

*SCHEDULE IS SUBJECT TO CHANGE OR CANCELLATION PENDING ENROLLMENT.

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