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Fall Enrollment - Credit Card

Please read all information on this form.


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.
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Male/Female Please select an item.
Age Required field.Invalid format.
Birthdate Required field.mm/dd/yyyy
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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.  




Credit Card Payment

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Card Number   Required field. 1234123412341234 format.
Exp Date   Required field.mm/yyyy format.
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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.  


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.


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.