Course Registration Form

Student Name

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Gender

Parent/ Guardian Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Mobile Number

Phone Number

Work Number

Any Medical concerns

Emergency contact

First NameLast Name

Emergency phone number

Please enter a valid phone number.

Courses

What day and studio location works best for you?

A confirmation phone call will be made once the form is filled out. Any questions feel free to call/text 585-750-7508

Tuition

Tuition is based on a yearly fee. Tuition will be billed in equal installments. May and June tuition will be due together no later than May 1st. There is no 1 class rate. Classes are billed once a month and are due no later than the 7th of each month. After the 7th of the month, tuition will increase by 20% per class. After 30 days of non-payment, the student will not be allowed to participate in class. Payments made after the 7th of the month will automatically be billed an extra 20% per class. * Payments are accepted in the form of a credit card through cash/check at the studio or Venmo - PAYMNDC. If you choose to use the portal to pay, there will be a 5% convenience fee for all credit card transactions. All costume fees and competition fees must be paid in cash at the studio. Returned check fee of $50 for all returned checks. We provide each dance family with a Portal account this will allow you access to your own account, make payments, register for classes, and more! We require an email address to pass other information along to you. Please make sure we are updated if your email changes or you are no longer receiving emails. Registration Fee $25 per student
1st Month Tuition Must be paid at the time of registration. Tuition will not be discounted if you dancer joins after the classes begin. All dancers will be billed in 10 equal installments with installments 9 & 10 due No later than May 1st. Payments are not based on months but rather broken into 10 payments. Our annual recital is tentatively scheduled for the end of May or the beginning of June.

Assumption of Risk

I understand that participation in class involves a risk of injury and I do hereby assume and accept risk inherent to the above-named participant’s activities at Miss Natale’s Dance Centre. I also agree to hold Miss Natale’s Dance Centre, it’s owners, employees and/or agents harmless for any loss or damage to my property and for injury and/or injuries, which might be sustained by me while participating in an activity at Miss Natale’s Dance Centre. I understand that it is my responsibility to maintain insurance coverage for myself or any medical expenses that might be incurred during my enrollment at Miss Natale’s Dance Centre by their agents. I have read the above and my signature indicates the understanding of Miss Natale’s Dance Centre assumption of risk policies and is given as part of the consideration for services rendered by Miss Natale’s Dance Centre and their agents. I grant Miss Natale’s Dance Centre my permission to use photographs for any legal use, including but not limited to publicity, copyright purposes, illustration, advertising, and web content. Furthermore, I understand that no royalty, fee, or other compensation shall become payable to me by reason of such use

All Regular Dance Classes - $48 /Monthly installments - $480 Per year 1 COSTUME @$88

Signature - I have read the above and agree to the payment arrangements and risks

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Miss Natale's Dance Centre

104 East Main Street

Avon, NY 14414

or pay venmo