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2012 Registration Form Form may be mailed,
faxed, or brought to the studio in person.
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First Name of Student:
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Last Name:
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Parent's Name:
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DOB of Student (mm/dd/yyyy):
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Home Phone #: Work Phone #:
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Parent Cell Phone #: Dancer Cell Phone #:
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Address:
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City:
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Zip:
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Parent's Email:
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Dancer's Email:
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Prior Dance Experience? How Long?
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Class Start Date:
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Teacher (s):
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2011 - 2012 Class(es)
Lesson day and time: 1.
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How did you hear about us? (if new student)
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2. 3.
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Any Medical Conditions we should be aware of?
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4. 5.
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Person Responsible for Payment (if other then Parent) Name and Phone #:
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6. 7.
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I and the student (if signing for a minor), have read and agree to the following rules and regulations of Broadway Rhythm
Dance Co.
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- Read and agree to the B.R.D.C. Dance Agreement (available at B.R.D.C.)
- The
above party agrees to pay the monthly tuition at the first class of each month. Otherwise a $10 late fee will apply
after the 10th.
- I agree to take full responsibility for any injury sustained during the participation
at Broadway Rhythm Dance Co. performances, classes, recitals, and other B.R.D.C. related events.
- I
consent that the student may receive emergency medical care for any injury as a result of participation. All attempts
will be made to contact a parent prior to a call for emergency medical care. If no contact can be made, 911 will be
called, if necessary. (The cost will be the responsibility of the parent or guardian).
- Tuition
is billed the same each month, regardless of holidays. A dance agreement will be given at the beginning of the season
stating dates B.R.D.C. is closed for holidays.
- Tuition is due the 10th of each month or a $10
late fee will apply. A bill will not be sent to you.
- Refunds will not be given for registration
deposits, tuition, missed classes, costume fees, or other fees.
- 30 day notice of withdrawl must
be given in writing to B.R.D.C.
- All new students are required to try their dance class for one
month. It is necessary to take the minimum of a month of lessons to decide if dance is right for you.
260
Parker Ave. Rodeo, CA 94572 (510) 799 - 2177 Phone (510) 245 - 2177 Fax
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Printed Name:
Date: Signed Name:
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Please call Broadway Rhythm for more information
(510) 799 - 2177
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Fees and Registration:
Monthly Tuition
$45 a month, one class per week for 45 minute classes.
$50 a month, one class per week for 60 minute classes.
Multiple Class Discounts for Immediate Family Members
If taking 2 classes per week, take 10% off your tuition.
If taking 3 classes per week, take 15% off your tuition.
If taking 4 or more classes per week, take 20% off your tuition.
*Tuition is billed the same each month regardless of holidays.
*Tuition is due by the 10th
of each month or a $10 late fee will apply. A monthly bill will not be sent to you.
*Refunds will
not be given for tuition or on shoe returns.
*Make-up classes may be available. Call to find out
if there is a class equivalent to yours.
*Classes scheduled are subject to change or cancellation.
* Appropriate attire and shoes must be worn to dance class.
--Every family is responsible for signing and agreeing to the studio policies.--
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(510) 799 - 2177
260 Parker Ave. Rodeo,
CA 94572
TrinasDanceCo@aol.com
Jazz Dance, Tap Dance, Ballet, Pointe, Filipino Folk Dancing,
Hip Hop, Rodeo, Hercules, Pinole, Richmond, San Pablo, El Sobrante, Crockett, Vallejo, Adults, Children, Boys, Girls, Private
Dance Lessons, Birthday Parties, Dance, Bay Area Dance Classes
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