2nd- 4th year - $22.00
5th year and up - $20.00
Class Fees- 1 Class- $12.50
2 Classes per week -$23.00
3 Classes per week - $33.00
4 Classes per week - $43.00
5 Classes per week - $53.00
10 Class card - $100.00
Recital Fees- $100.00 per dance subject taken
THE PHILADELPHIASCHOOL OF DANCE ARTS
9 North Preston Street • Philadelphia, PA19104 • 215-387-8202
2100 East Washington Lane • Philadelphia, PA19150 • 215-424-9811
STUDENT REGISTRATION FORM 2010-2011
STUDENT INFORMATIONLast Name / First Name/Middle Initial / Date of Birth / Age
Address / City/State / Zip Code
Home Phone / Cell Phone: / E-Mail:
Do you have any Health Issues?
Do you take medications? / Please list any medications/health issues?
PARENT/EMERGENCY INFORMATION
Parent/Guardian / Home Phone / Cell Phone / Work Phone
Address / City/State / Zip Code / E-mail
Emergency Contact / Home Phone / Cell Phone / Work Phone
Address / City / State / Zip Code
Billing name & address if different than those listed above.
CLASSES
Previous dance study?
Yes No / If yes, what type and length of study? / Where?(School/Teacher)
Classes to be taken this term
Pre-Dance / Ballet / Modern Jazz / Tap
Modern Dance / Hip Hop / Acrobatics / Other
Absolutely, NO PERSONAL CHECKS will be accepted (MONEY ORDERS/CERTIFIED CHECKS ARE ACCEPTABLE) at any time. Please do not send payments with young children. All certified checks and money orders are made payable to Joan Myers Brown. All major credit cards are accepted.
IMPORTANT
All payments are due and payable in advance or at the time of class taken. Registration fees and Recital fees are not refundable. Any person more than two weeks in arrears with their payments will be automatically dropped from classes until their payments are brought up to date. I have read and fully understand and agree to the above statements.
Please read carefully before signing
We operate under the assumed risk clause. You attend at your own risk. The school is not responsible for injuries obtained outside of the building or mishaps because of folly in the classrooms, dressing rooms, etc. We will not be responsible for any valuables lost or stolen on premises. Students should leave all valuables at home, including large sums of money. If for some reason valuables are brought to school, they should be left at the front desk or with the teacher. Clothing should be placed in the lockers located in the dressing rooms (you provide your own lock).
Please Note: The recital and registration fees are NON-REFUNDABLE. The recital fee is applicable to two(2) recital tickets for non-participants. All participating students are responsible for 10 tickets to the recital.
SIGNATURE (student/guardian) ______DATE:______
PAYMENTS (Official use only) / Date:REGISTRATION / CLASSES / RECITAL FEES / WEEKLY RATES
(email)