Registration Form 2011-2012 for The Dance Junction

(print separate page for each student)

215-693-1208       www.thedancejunction.com     thedancejunction@comcast.net

Register by mail or phone.  Pay by cash or check only.  Return this form with Reg. Fee and Tuition.  

Mail to:    536 Tori Court     New Hope, PA  18938

Student Name/Age/Birthdate:

Parent:

Address:

Phones:

Email:

Class Days and Times:

Payment:      $30.00 Registration Fee per family

1 class a week $200.00 per trimester       2 classes a week $345.00 per trimester

3 classes a week $445.00 per trimester     4 or more classes a week $495.00 per trimester

Families receive a 15% discount off total tuition only.  Please add your registration fee in full after taking your discount.

Total with $30.00 Registration Fee, first trimester payment, less any discount on tuition:

Release from liability:   I recognize and accept that there is risk inherent in participation in group and/or physical activity, including the classes offered at The Dance Junction.  I and my child will be attending, or just my child, and I will forever release and discharge The Dance Junction and Jill Kalfin, and any instructors or staff from any and all liability and claims resulting from bodily injury, property damage or other loss sustained in connection with such classes.

Signature of Parent________________________________________________Date________________________________