PEACHTREE CITY SCHOOL OF DANCE

2013-2014 DANCE REGISTRATION FORM

FOR OFFICE USE ONLY: Peachtree City School of Dance Bring A Friend Student: 113 Peachtree Court, Suite A When Applied: Fayetteville, GA 30215 Website: www.PTCSchoolofDance.com E-mail: PTCSchoolofDance@comcast.net Phone: (770) 632-1544

MAIL WITH REGISTRATION FEE TO:

Parents Name: _________________________________________________ Students Name: _________________________________________________ Age: ______________ Birthday: ______________________________ Gender: F M

Address: _____________________________ City: _____________________ Zip code: ____________ Phone Home & Cell: _____________________________________ Work Phone: _________________ E-mail address: ____________________________________________ Emergency Contact Name & Phone: _________________________________________ List Any Health Concerns or Allergies: _______________________________________ Class(es) Day & Time: TUITION See Page 2 and ask for Terms & Conditions at the Desk for all terms & conditions Monthly Tuition: 1st 1 hour class per week - $55 per month 2nd and subsequent 1 hour class per week - $45 per month (1 hour class is $77.50 per month) Dancer will not participate in 2014 Spring Recital; attach recital form.

MONTHLY TUITION DUE __________

NON-REFUNDALBE REGISTRATION FEE. $25 Monthly tuition is due on or before the 1st lesson of each month. TOTAL AMOUNT DUE _______ There is a $10 late fee charged after the 5th of the month. There is a charge of $35 for any returned check. A discount for paying the full year in advance is offered (August - May). 30 Day WRITTEN NOTICE REQUIRED FOR WITHDRAWAL.

All Payments to be made Payable to: Peachtree City School of Dance.

The undersigned agree to all terms & condition, policies and releases herein and as presented in referenced documents available at each location of Peachtree City School of Dance.
Signature ________________________________________ Date __________________
(Parent or Guardian for Child or Adult for Self)

MONTHLY TUITION IS DUE ON OR BEFORE THE FIRST OF EACH MONTH.

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1. Release Peachtree City School of Dance, Inc. (here after refer as School) assumes no liability for
accidents, injury, or loss of property. The person signing on behalf of the student assumes responsibility thereof. The parent or guardian release and authorize the School use of any photos or video taken during dance activities, including classes for use in advertising, performance programs, brochures or other commercial uses. I hereby authorize the School to act for me in the event of a serious emergency (requiring medical attention) and I hereby waive and release the School, its instructors, teachers, and/or directors from any and all liability for injuries and illnesses incurred while in attendance. Furthermore, in the event of an emergency requiring medical attention, the parent or guardian shall pay for all services rendered. Medical Liability Peachtree City School of Dance, Inc. is not liable for any unforeseen medical condition that might arise from participation in the programs at Peachtree City School of Dance or other location. Peachtree City School of Dance, Inc. reserves the right to request a parent or guardian not to leave a student or immediately come and pick-up a student that appears to be in our judgment to be ill or injured. If the parent or guardian is not available, not able to be reached or not willing to pick up the student, then Peachtree City School of Dance, Inc. has the right and duty to call the appropriate services to attend to the students needs. The parent or guardian is responsible for all payments for any services, medical attention, or transportation costs associated with such an event. If other costs are associated with the event that are incurred by Peachtree City School of Dance, Inc., the parent or guardian will reimburse Peachtree City School of Dance, Inc. all costs and reasonable inconvenience associated with this emergency. Withdrawal Student withdrawal from a class must be done in writing a minimum of 30 days before actual withdrawal date. Charges will continue to be accessed through the end of the withdrawal date confirmed by Peachtree City School of Dance. This may be done by the parent or guardian listed on the account sending a letter sent to the address listed above or e-mail. Written notification to include: Parent name on the account, Students Name, Class or Classes withdrawing, & effective withdrawal date; or send an e-mail to PTCSchoolofDance@comcast.net attention BOB with the same information. If a student withdraws in the middle of the year and returns within that same dance/musical drama season, then a $25 re-enrollment fee may be charged. All withdrawal requests received will be confirmed by return email within 5 business days after receipt of the notice to withdrawal by the Studio. All balances must be addressed prior to the effective withdrawal date. If you do not receive an e-mail confirming the withdrawal, we have not received notification of the withdrawal request. It is the parent or guardians responsibility to contact the studio and get a confirmation of withdrawal. Any classes missed may be made up within 1 month of the class missed. See the Desk for time and dates to schedule a make-up class. It is the responsibility of the Parent or Guardian to schedule any make-up classes Class schedule are based on a minimum number of students in a class. Classes may be canceled if the minimum numbers of students are not registered or reasons deemed by the Studio. Class schedules may be changed with proper notice to meet students and studio needs at the options of the studio. Notification of enrolled students will be current e-mail address in the studios file. Refunds for canceled classes will be a pro-rated value of unused classes. Information is sent by electronic means, normally by e-mail, on our website, or posted on our Facebook Fan Page. We request parents or guardians give their e-mail address they want this information to be sent; please give your e-mail at time of class registration and additional e-mail address that the parent or guardian would like the information sent. We encourage all dancers and parents become a Fan on our Facebook Fan Page, to become a fan Request Peachtree City School of Dance. If you are not receiving information at least once per month, notify the desk to check if we have the correct information in the system. Communication is important for everyone to understand the progress of your student. At Peachtree City School of Dance, Inc. we understand the need for good and open communication. If you have any questions, concerns, suggestions or other reason to communicate with us please feel free to send us an e-mail at PTCSchoolofDance@comcast.net or Director@PTCSchoolofDance.com and we will be happy to respond to your need. Class Requirements are noted in our brochure. For complete list of Terms and conditions please contact the studio or see someone at the Front Desk. 2of 2
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