Enrollment Form

Submitted by dcdadmin on January 8, 2010 - 4:19pm

Student Name: *

Date of Birth: *

Parent / Legal Guardian: *

Email: *

Address

Address: *

City: *

State: *

Zip: *

Phone: *

Driver's License Number: *

How did you hear about us: *

Classes and Date/Time: *

Please specify the class(es) and it's date/time that you're interested in.

Policy and Procedures: *

I Agree

I Do Not Agree

Policy and Procedures of Dance Industry Performing Arts Center:
I understand that lessons must be paid for whether attended or not and the monthly tuition is due between the 1st and 5th of each month. All tuition is counted late after the 6th of which a $15 late fee will then apply. I am aware that teachers are not allowed to withdraw students and that I must submit a written notice of withdrawal to the front office in order to withdraw my child from dance classes. If I withdraw my child after the 1st of the month I am responsible for the full month of tuition. I understand that any classes missed can be made up within a 2 week period as long as my tuition is current. I understand that classes can be changed as long as the office is notified and the change has been approved by the instructor. If my child changes classes more than 3 times an additional $10 fee will be charged. I understand once a costume is ordered I must pay the fee in full before the December holiday break. I understand that communication between the studio and I will be made mainly via email, and postings on the DIPAC informational board; therefore it is my responsibility to stay informed with regards to all updates and events for DIPAC.

Tuition is a flat rate every month. No pro-rated tuition or refunds will be considered for students’ attendance. Fees are the same each month even though the number of classes held may vary. Holidays are not pro-rated nor are there any additional fees for months with 5 weeks of classes.

DIPAC observes PISD school calendar with exception of teacher in-service days.

Recital fees are required for each student. This fee is non-refundable.

Newsletters are printed monthly with events, holidays and studio updates.

I acknowledge by clicking "I Agree", that I have read the above statements and agree to these terms and conditions.

Medical Release

Insurance Carrier: *

List All Medication Allergies: *

Insert None if No Allergies

List All Medications Currently Taken: *

Insert None if Not taking any medication

Any Other Pertinent Medical Facts: *

Insert None if Not Available

Medical Release and Liability Agreement: *

I Agree

I Do Not Agree

Click here to read our Medical Release and Liability Agreement. You are not required to fill out the form.