2010-2011 Studio Registration Form

Please complete the form below:

Parent/Guardian Name	*
Last Name	*
Email Address	*
Cell Phone Number	*
Home Phone Number
Additional Parent/Guardian's Name
Phone Number
Email Address
Mailing Address	*
City	*
State / Province
Zip / Postal	*
Student #1's Name	*
Date of Birth (MM/DD/YYYY)	*
Student #1's Email
Student's Cell Phone Number (if available)
Student #2's Name
Date of Birth (MM/DD/YYYY)
Student #2's Email
Student's Cell Phone Number (if available)
Primary Doctor's Name	*
Phone	*
Any medical conditions or allergies that we need to be aware of?
CREDIT CARD INFORMATION
Tuition is based on a yearly fee that is divided into ten equal payments. This tuition is due even when the student is not present for classes, unless they have officially withdrawn from the school. Tuition must be paid by the beginning of each month. A credit card needs to be on file. Tuition fees not paid by the 1st of the month will be considered late and will incur a $25 late fee. Registration Fee: Registration Fee for the Fall is $75 for the first child & $50 for the second, however if you register and pay by Friday August 6th you will pay the discounted rate of $65 for the first child and $40 for the second. SECURITY: Your credit card information is SAFE and SECURE. Your data is transmitted via a secure (SSL) connection.
Credit Card Holder's Name *
Credit Card Number *
Expiration Date * Enter as: M/YR (ie: 08/12)
CCV Number * 3 Digit Security Code #. For Amex, please enter 4 digit security code on front of card)
Terms and Conditions
Please take a moment to review our terms and conditions. To register at our studio you must agree to them. Please click here to review them.
Do you agree to the terms and conditions?	*	YES
Comments, questions, concerns?
Once you submit your registration, we will process it and contact you to complete enrollment. Thank You!
Please Enter Your Full Name as your Signature:	*