The Ballet Academy of Moses Lake

The Ballet Academy of Moses Lake

2017-2018 Registration Form

Student First Name ______Last Name ______

Age______D.O.B______School Attending______

Mailing Address______State______Zip______

Mothers Name______Phone #______

Fathers Name______Phone #______

Students Phone #______Any Health problems we need to be aware of______

Email______

Emergency Contact______Phone #______

Monthly Prices classes a week Amount Family tuition Discounts (please circle one if applies)

1$45 2nd child 10% off

2$75 3rd child 15% off

3$105 4th child 20% off

4$135 5th child 25% off

5$150 Private Lessons $50 hr.

6$175 Studio time $ 20 hr. for BAML students $40 hr. for non BAML students

Unlimited $210 Drop-in $20 per class I

INITIAL ALL BULLETSYearly Registration Fee $20 per family Costume Fees $65 per costume

I fully understand and acknowledge that by registering my child for any dance classes that they are required to take the indicated days and times set on the schedule.

Classes Attending Days a wk Costume Y or N

1)______

2)______

3)______

4)______

5)______

6)______

7)______

Total # of classes a week______Tuition total $______@ ______% off

Total number of costumes ______X $65 per costume equals $______

Total Amount paid $______

Please check box if you would like to make payments on costumes until paid for in full. Please indicate how many you are paying for today in the space below

Initial All Bullets

I agree to pay all monthly tuition and fees according to payment schedule and understand late charges will be assessed to my account if not paid on time. Additionally, I agree that once my fees (including monthly tuition, costumes, private lessons etc.) have been paid they are non-refundable or transferable. I understand that I am signing up for the full 2017-2018 season.
I fully understand and acknowledge that tuition is due at the beginning of each month and that there will be a $25 late fee applied if payment is received after the 10th of each month. I also acknowledge that I am registering my child for the full 2017-2018 season and MUST fill out an early withdrawal/transfer form prior to the beginning of the month if any of the above classes change or need to be dropped or I will be responsible for the full month tuition and all late fees. There will be a $35 NSF fee for all returned checks.
I acknowledge and realize that any missed or canceled classes are my responsibility to schedule make up times.

I fully understand and acknowledge that in allowing my child to participate and dance at the Ballet Academy of Moses Lake that there is always a risk of injury and will NOT hold The Ballet Academy of Moses Lake, Lacey Stowers, Rian MIles or any other persons representing or teaching/instructing at the Ballet Academy of Moses Lake responsible for any injuries acquired by my child or any other child in such case. I understand that any medical needs or cost due to my or any other child being injured while participating in this program are NOT the responsibility of B.A.M.L , Lacey Stowers, Rian Miles or any other persons representing The Ballet Academy of Moses Lake.

I give also The Ballet Academy of Moses Lake my full permission to use my child’s picture and video for advertisement and marketing.

I acknowledge that proper dance class attire is required and will be upheld at all times

______

Parent and or Guardian signature Date

Official use only

Student class placement