2520 A Las Posas Road • Camarillo, CA 93010 • 805-383-6446 • Fax 805-383-3105
REGISTRATION FORM/AUTOMATIC PAYMENT CONSENT
Student’s Last Name: ______Student’s First Name: ______
□M □F Student Birth Date: ______Parent’s Name(s): ______
Primary Phone #:______Phone #2: ______
E-mail:______
Address: ______
StreetCityZip Code
Medical Conditions: ______
Emergency Contact (other than parent):
Name: ______Phone: ______
Date Registered: ______Date Starting Classes: ______
Month Day Year
How did you hear about us: ______
______
Method of Payment
□Visa □MasterCard □Debit ______Sec. Code ______
Card Holder’s Name ______Expiration Date ______
I hereby authorize Camarillo Academy of Performing Arts to charge my account for the following amounts:
$ ______for tuition on the first day of each month starting ______and ending ______
and $ ______on ______for Recital Performance Fee.
All charges will appear as Camarillo Academy of Performing Arts.
______
Signature
______
OFFICE USE ONLY:
CLASSES:
Class 1 / Day/Time / Inst. / Class 9 / Day/Time / Inst.Class 2 / Day/Time / Inst. / Class 10 / Day/Time / Inst.
Class 3 / Day/Time / Inst. / Class 11 / Day/Time / Inst.
Class 4 / Day/Time / Inst. / Class 12 / Day/Time / Inst.
Class 5 / Day/Time / Inst. / Class 13 / Day/Time / Inst.
Class 6 / Day/Time / Inst. / Class 14 / Day/Time / Inst.
Class 7 / Day/Time / Inst. / Class 15 / Day/Time / Inst.
Class 8 / Day/Time / Inst. / Class 16 / Day/Time / Inst.
Policies and Procedures
Registration: A non-refundable fee of $35 for one child and $20 for each additional family member living in the same household is paid at the time of registration for all new students and returning students that do not register before September 1, 2017.
Facility Improvement Fee: A yearly fee of $25 per family is paid at the time of re-registration. This fee covers studio improvements and general maintenance. We welcome all input as to needed renovations and updates via email to .
Recital Performance Package Fee: Includes venue rental costs and other expenses involved with event production, one costume, one commemorative DVD, souvenir tee shirt, practice CD or digital download, and a photo. Additional classes may require additional costume purchases. Costume and Recital Performance Package Fees are NON-REFUNDABLE and NON-TRANSFERABLE.
Tuition: Tuition will be charged monthly. There is a $15.00 fee for any declined auto payments. Failure to pay tuition within 30 days will result in classes being suspended. There will be no discounts or refunds given for missed classes; however, make-up classes are available.
Payment of Fees: Tuition must be paid by automatic bank debit card or automatic credit card payment. Tuition will be charged on the 1st of each month from September through July. Credit card or debit payments are not accepted for in-person payments on a monthly basis. Payment must be made by preauthorized automatic monthly payment, or by payment of the year in advance via cash, check or credit card. All charges will appear on your bank statement or credit card statement as being from Camarillo Academy of Performing Arts.
NSF Payments:
_____ I hereby authorize the school to electronically charge for the amount of any NSF paper check or auto-debit transactions plus a $25 NSF fee, per transaction.
To drop a class, students must do the following:
_____ 1. Obtain a drop form from the front desk, email or in writing.
_____ 2. Return the drop form in person to the front desk by the 15th day of the student’s final month of attendance. If a drop form is turned in on or after the 16th, the entire following month’s tuition will be due. Drop forms must be turned in to the front desk—phone calls will not be accepted.
_____ 3. Dropping a class will result in forfeiture of all tuition payments, make-up classes, registration and recital fees. Any ordered costumes may be picked up between July 1 and September 1 of the same calendar year. As of September 1, all unclaimed costumes will be disposed of.
Substitutions: The school reserves the right to provide a substitute instructor if the regularly scheduled instructor is ill or otherwise unable to teach. If an instructor is ill and a substitute cannot be arranged any missed classes can be made up.
Photo Release: The school is hereby granted permission to take photographs of the students to use in brochures, web sites, posters, advertisements and other promotional materials the school creates. Permission is also hereby granted for the school to copyright such photographs in its name.
Student Waiver and Release of Liability
I have obtained a copy of the Student Policies and Procedures and will take the responsibility to carefully read and follow the rules and policies therein. I understand that Camarillo Academy of Performing Arts does not give credit and/or refunds for class(es) missed due to holiday, vacation, illness, weather, etc. further understand that there are specific risks of physical and/or property damages, losses, or injury that may result from my child’s participation with Camarillo Academy of Performing Arts and I voluntarily assume the risks associated with such participation.
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Date Student Name (please print) Signature of Parent or Adult Students CAPA
(Office Use Only)
Date ActionNew Information Initials