Student's Name
DOB
Age
City
Address
Zip
Mother's Name
Father's Name
Home Phone
Cell Phone
Work Phone
Emergency
Contact Person
Phone Number
GIRLS AND BOYS * * AGES 3 THRU ADULT
PROFESSIONAL DANCE INSTRUCTION OFFERED IN:
(Please check all that apply)
Ballet
Jazz/Tap
Modern
Lyrical
Acrobats
Break Dance
Pointe
Hip Hop
INTERMEDIATE
BEGINNER
ADVANCED
I understand that this is a yearly activity and that the regular season starts in September and ends at the
conclusion of our yearly recital. You have a 60-day grace period starting with the first day of our regular
season to decide whether or not your child wishes to continue to participate in class. If you decide not to
continue with lessons during the 60-day grace period, simply notify the desk by phone or in person of your
decision. If you or your child decide not to continue after this period, the parent/guardian is responsible for
payment in full of all your child’s classes for the remainder of the season including costume costs. I understand
that if my child is absent from classes for any reason, I am still responsible to pay for the missed lessons.
Tuition is paid on a monthly basis and will not be pro-rated for any reason including but not limited to illness,
weather conditions, and holidays. Dance Xtreme has my permission to use any class, competition, or other
photos which include the likeness of my child on their printed studio material and website.
I understand that in the event of any accident or injury, Dance Xtreme and staff are not liable.
All new students are charged a $25 non-refundable registration fee payable on the first day of classes. The
registration form must be completed at the studio with a signature from the parent or student if 18 years or older
before you are eligible to start classes.
I Agree to the terms above.
REGISTER NOW!
