(770) 787-4333



Rhythm Elements...Wher​e Creativity and Talent Grow!

Register Now

REGISTRATION FORM

Join the fun and excitement! Our 2017-2018 Fall Dance Season is currently open for registration! The season runs August 1st-May 31st.   


Classes are for ages 2.5 to Adult.  To sign-up for Dance, Acting and Tumbling / Acro classes, simply print out the Registration form below, fill it out and mail your payment and completed Registration Form to Rhythm Elements Dance Studio 2124 Main Street, Porterdale, GA  30014.  You can also bring the completed Registration Form to the studio or click link to register online at http://www.rhythmelements.com/online-payment  via our website.  Any questions or assistance needed, please feel free to call us at (770) 787-4333.    


RHYTHM ELEMENTS DANCE STUDIO

                                                                                                               Session: _________________________________

                                                                                                               Sign-up Date: _____________________________

New Student Registration Form

Student Information

Student’s Name: _______________________________ Date of Birth (MM/DD/YYYY): _______________

Mailing Address: ______________________________________________________________________

Primary Phone: ________________________________ Phone (2): _____________________________

Name of Person responsible for paying fees: _______________________________________________

Primary Email Address: ________________________________________________________________

Primary Billing Phone # ______________________________

Legal Release and Policy Acceptance (please initial)

___ I/we understand the Studio Policies                                     ___I/we understand my billing obligations

___ I/we understand the risks related to dance                      ___ I/we understand my responsibilities for my property

___ I/we understand the dress code                                            ___ I/we understand the schedule

___ I/we give media use rights permission                               ___ I/we understand the attendance policy

___________________________________                              ____________________________________

Signature / Responsible Party                                                        Date


Classes

Class Name                                                     Meeting Date(s) / Time                                      Fees / Minutes

_____________________                         ________________________                         __________________

_____________________                         ________________________                         __________________

_____________________                         ________________________                        ___________________

_____________________                         ________________________                        ___________________


Please fill out all that applies:

Registration Fee: _______________                                                                    Showcase Fee: ______________

Tuition: ______________________                                                                      Costume Fee: _______________

Discounts: ____________________                                                                      Comp Fees: ________________

Total Monthly Tuition __________                                                                      Private Lessons Fee:__________

Measurements

_____ Height                      _____ Girth                        _____ Tights Size

_____ Shoe Size                _____ Inseam                   _____  Leotard Size

Medical

Allergies: ____________________________________________________________________________

Will your child require any special medical attention during a normal class: (yes/no) ______________

If yes – Explain: _______________________________________________________________________




[ ] – Recorded    [ ] Paid in full    [ ] On hold Processed by: ________   Special Notes: ________________

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