• OXFORD CENTER FOR DANCE, INC.

    Release/Registration Form Fall 2021-2022
  • 2371 BALTIMORE PIKE OXFORD, PA 19363

    Dina Gazzerro-Kinney - Director

    610-932-3267

    www.oc4dance.com

    oc4dance@zoominternet.net

    • Family Information  
    • The Address field is  REQUIRED.  If you do not have any information to enter into "Street Address Line 2", please enter NA or Not Applicable.  If you do not put text in that field the form submission will FAIL

    • Place of Employment

    • Emergency Contact (not living at same address)

    • Student Information (First Student)  
    • *If different address than entered into address under Family Information, please enter student's address below

    • If Registering more than ONE student, please complete the additional Student Information Section below.  If Registering ONLY one student, please continue to the Dance Registration Section

    • Student Information (Second Student)  
    • *If different address than entered into address under Family Information, please enter student's address below

    • If Registering more than TWO students, please complete the additional Student Information Section below.  If Registering ONLY two students, please continue to the Dance Registration Section

    • Student Information (Third Student)  
    • *If different address than entered into address under Family Information, please enter student's address below

    • Signature  
    • I give permission for the student(s) named above to receive instruction at Oxford Center for Dance, Inc. I give permission for any photos and/or videos taken of my child/children named above to be published in any Oxford Center for Dance, Inc. advertising, promotions, websites, yearbooks, etc. I have received a copy of the rules and regulations. I have read and agree to abide by all of them. I release and discharge the sponsoring organization, Oxford Center for Dance, Inc., it’s agents, servants, and employees from any and all claims for personal injuries or property damage sustained by the student(s) named above while in or around the present studio location as well as during off premises activities such as, but not limited to yearly competitions, meets, conventions and seminars.

    • **COMPLETELY FILL OUT ALL PERTINENT INFORMATION ON THIS FORM**

      ****INCOMPLETE FORMS WILL CAUSE DELAY IN REGISTRATION****

    • Dance Registration Information  
    •  
    • Registration Fees (Non Refundable)  
    • prev next ( X )




      Total   $ 0.00
    • $25.00 NON-Refundable Registration Fee Per Child!

      Registration fee will not be subtracted from tuition & IS NOT REFUNDABLE.

      NO CREDITS OR REFUNDS GIVEN IF STUDENT DROPS A CLASS OR CLASSES

      ALL TUITION PAYMENTS ARE DUE THE FIRST WEEK OF EACH MONTH.

      A $10.00 LATE FEE PER MONTH WILL BE ADDED TO ALL OVERDUE ACCOUNTS

    •  -  - Pick a Date
    • Should be Empty: