FOOTPRINTS DANCE STUDIO

Registration Form 2010-2011

Student’s Name (Last, First, MI)____________________________________________________________

Parent’s Names (First & Last Name) ________________________________________________________

Address_______________________________________________City__________________Zip________

Home Phone _____________Mother cell _____________Father cell _______________Other___________

E-Mail Address__________________________________________(Used only for communication purposes)

Birth Date_____________ Age_______ School ____________________________________ Grade_______

New Students Only: Yrs in training: Ballet ____Pointe ____Tap ____Jazz ____Contemporary ____other____

Studio last attended: _________________________________________________Year_______

How did you hear about our studio? ________________________________________________________

I acknowledge that I have received, read and will comply with the Studio Policies. I will not hold Footprints Dance Studio, LLC or any of its
agents, employees, or representatives liable for any injuries sustained or illnesses contracted by me while a student attending this studio.

________________________________________ ____________________________________________
Student’s Signature Parent’s Signature (If student is under 18 yrs)
Class Assignments
Class_________________________________________ Class __________________________________________

Day/time__________________________________ Day/time____________________________________

Class_________________________________________ Class __________________________________________

Day/time__________________________________ Day/time____________________________________

Class_________________________________________ Class __________________________________________

Day/time__________________________________ Day/time____________________________________

Class_________________________________________ Class __________________________________________

Day/time__________________________________ Day/time____________________________________

“Siblings” also attending studio: names & # of hours _____________________________________

_______________________________________________________________________________
TUITION AND PAYMENT INFORMATION
Total # hrs / week________________ ______ Non-Refundable Registration fee: $_________

Total monthly tuition $___________________

(Due on the 1st class day of each month
$20 Late Fee added after 10thof Month.)

September tuition: $_________

10%Disc w/ Full Yr Tuition Pymt $_________

TOTAL DUE NOW: $_________

Footprints Dance Studio LLC 10125-B South Sheridan –Tulsa, OK 74133 (918) 845-6988
www.footprintsdancestudio.com