Fall Enrollment - Credit Card

Please read all information on this form.

ENROLLMENT FORM INFORMATION
Complete the enrollment form entirely.
A registration fee of $15 must be submitted for each Fall Enrollment form.
September tuition can be paid with the registration fee or paid the first week of class.
One Fall Enrollment form required per student.
Submitting the form is acceptance of the parent signature required.
Students registering early will have first choice of the days and times available.
Studio will notify students ONLY if:
                A. Class is already filled.
                B. Incorrect classes were chosen.
                C. Students enrolled in incorrect age groups.
                D. Class has been canceled or changed.
When selecting dance codes, remember to enroll in the correct age group.
All classes will begin Friday, September 6, 2013.


Student Information
First Name Required field.
Last Name Required field.
Male/Female Please select an item.
Age Required field.Invalid format.
Birthdate Required field.mm/dd/yyyy
Experience Required field.
     
Address Required field.
City Required field.
Zip 48XXX format requiredRequired field.
Home phone Required field.5861231234 format requiredUse all 0's if you do not have a home phone.
Cell phone 5861231234 format requiredRequired field.
email Required Field.
     

 

Dance Codes
Please use the boxes provided to enter your codes you wish to register for.

Use one box per code.
Required field.  

ALL CLASSES START SATURDAY, SEPTEMBER 10, 2011.

 

 
 
 
 
 
 
 
 

Credit Card Payment
Card Type   Please select an item. A $15.00 NON–REFUNDABLE REGISTRATION FEE MUST BE SUBMITTED. REGISTRATION WILL NOT BE PROCESSED UNTIL PAYMENT IS RECEIVED.

SEPTEMBER TUITION CAN ALSO BE PAID WITH THE REGISTRATION CHECK OR PAID THE FIRST WEEK OF CLASS.
Name on card   Required field.
Card Number   Required field. 1234123412341234 format.
Exp Date   Required field.mm/yyyy format.
CCV code   Required field.Numbers only.
     
Registration Fee $ 15.00 required.15.00 required.  
September Tuition $ Required field.use 0 or 0.00 format. Insert 0 if you are only paying the registration fee.
Sub Total $ Required field.use 0 or 0.00 format.  
3% Credit card fee $ Required field.use 0 or 0.00 format.  
Total amount paid $ Required field.use 0 or 0.00 format.  

Tuition

No. of Classes

1st Child 2nd Child
1 Class (per month) $36 $34
2 Classes (per month) $70 $66
3 Classes (per month) $99 $93
4 Classes (per month) $124 $116
5 Classes (per month) $145 $135
6 Classes (per month) $155 $143
Unlimited $165 $150

3rd child is free and male dancers are 1/2 price.


Comments  

All students, parents/guardian are aware of possible injury that may occur during any dance class, performances, rehearsals, competition or any other studio related activity and are willing to assume those risks. I hereby release Tina Marie School of Dance, the owner, directors, staff and employees responsible for any damages or liabilities due to injury, accident, or property loss during or resulting from my child's participation in any function or activity through Tina Marie School of Dance. Tina Marie School of Dance has permission to use my child’s photographs, images &/or video recordings on the Tina Marie School of Dance website and in its publications.

By submitting this form you have have read all the information above and agree.    
      Input boxes highlighted in pink require information or corrections.