Registration Form

Registration Form

Student Name *:

Grade *:

School *:

DOB *:

Parent/Guardian Name *:

Address *:

Home Phone:

Cell*:

Work:

Email *:

  

Emergency Contact*

1. Name *:

Phone*:

Relationship:

2. Name:

Phone:

Relationship:

Please list any medical conditions that your child has so we are aware:


Initial: For any emergency, I give permission to Velocity Staff members to call 911

Annual Membership Fee is $25 Per Family

Includes Special Membership Fee For: Vacation, Summer Camp, Birthday Parties, and other activities throughout the year

Class Tuition

45 Minutes Per Week
60 Minutes Per Week
90 Minutes Per Week
$45 Monthly
$50 Monthly $55 Musical
$70 Monthly

Ballet Tuition

60 Minutes Per Week
30 Minutes Pointe Per Week
$55 Monthly
$30 Monthly

Discounts

3-4 Hours 20%
5 Hours 25%
6+ Hours 30%

Dance Program Request

ClassA:

ClassB:

ClassC:

Payment Options:

 Credit Card

MONTHLY TUITION:

I agree and understand Velocity Dance Company Inc., will charge my account the total tuition amount reflected above on the 1st of the month of September-June. 30 days written notice must be given to request auto payment to be terminated. By signing, I am accepting all responsibility for these charges and to ensure full payment to Velocity Dance Company. I will immediately notify Velocity Dance Company if the card provided is no longer valid and will provide a new alternative payment. I present that I am the authorized cardholder.

I have read and understand this release

Name*:

Date*:

Initial: Yes, I approve for Velocity Dance to utilize my child’s photo for any marketing purposes