START CLASSES TODAY!

Please print out the Registration form below, and bring the completed Registration Form to the studio.  Or, click link to pay tuition 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

NEW STUDENT REGISTRATION FORM

CLASS(ES): ________________________________

Sign-up Date: _______________________________

Student Information

Student 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 # _______________________________________________

I understand that dance classes may include, without limitation, dancing with props, stretching, barre work, across the floor combinations, dance routines in the center, and other related activities.  I further understand that all of the activities of the dance class involve some degree of risk of strain or bodily injury.  

Rhythm Elements Dance Studio is not responsible for personal property.

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 at the studio

 [  ] I/we understand the dress code                                              

 [  ] I/we understand the schedule 

 [  ] I/we give media use rights permission, without compensation                                

 [  ] I/we understand the attendance policy

Signature / Responsible Party: ____________________________      Date: _________________

Classes

Class Name                                                            Date(s) / Time                                  Fees 

________________________________                _________________                       _______________

________________________________                _________________                       _______________

________________________________                _________________                       _______________

Showcase Fee: ____________________ 

Tuition: __________________________                                                                                                                                           

Total Monthly Tuition _______________

Private Lessons Fee:_________________

Medical Allergies: ___________________________________________________________________________

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

If yes – Explain: _____________________________________________________________________________

OFFICE USE ONLY - DO NOT FILL-IN BELOW THIS LINE

___________________________________________________________________________________________

[  ] – Recorded    [  ] Paid in full    [  ] On hold    Processed by: ____________________

Special Notes: ___________________________________________________________

Powered by: DanceStudio-Pro.com