ALGONQUIN ACADEMY OF DANCE

FALL JANUARY
(CIRCLE ONE)

SUMMER

Student Last Name: _____________________________ Student First Name: _____________________

Age: ______ Birth date: ______________ Grade: ______ School: _______________________________
Guardian 1 Name: ____________________________________ Relation: ________________________
Guardian 2 Name: ____________________________________ Relation: ________________________
Address: __________________________________ City: _______________________ Zip: __________

EMERGENCY CONTACTS
Home Phone:

Guardian 1 Cell:
Guardian 1 Work:

)
(

Guardian 2 Cell:
)_________________

GENERAL INFORMATION

START DANCE REGISTRATION FOR YEAR _________

)________________

)____________________

Guardian 2 Work: (

)____________________

Fax:

)______________________________

Family E-mail:______________________________________

FIRST CLASS:

Level: ______________________ Day: ______________ Time: ____________

SECOND CLASS:

Level: ______________________

Day: ______________ Time: ____________

THIRD CLASS:

Level: ______________________

Day: ______________ Time: ____________

FOURTH CLASS:

Level: ______________________

Day: ______________ Time: ____________

ATTENDANCE: Students are expected to maintain

regular attendance in the class of enrollment.
REGISTRATION: A $40.00 non-refundable fall
registration fee ($20 goes towards the recital costume) is
due for each class at the time of registration. One $20.00
non-refundable summer registration fee is due at the
time of registration.
ABSENCES: Students are invited to make up any
missed classes in another class that is appropriate. Make
up classes can be taken any time within the current
session, as long as the student is still enrolled. There are
no refunds for missed classes.
PAYMENT: Monthly payments for the fall session
are made by charge card authorization, post-dated
checks, or cash (additional fee). The fall session has nine
installments due (September-May). Full payment for the
summer session is due at time of registration.
WITHDRAWAL PROCEDURES: If for any
reason your child can no longer participate, you MUST
fill out a withdrawal form in person. Tuition will continue
to be charged until procedures have been followed.
REFUNDS: The registration fee is non-refundable.
There are no refunds for missed classes, unless the
studio cancels a class.

Thank you for choosing the

Algonquin Academy Dance!
Signature of adult student, parent, or guardian:

FIFTH CLASS:

Level: ______________________

Day: ______________ Time: ____________

Previous Experience-Subject(s) studied, where, & # of years: ___________________________________

__________________________________________

How did you hear about the studio? _______________________________________________________

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