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

$60 Monthly
$65 Monthly
$79 Monthly

Ballet Tuition

60 Minutes Per Week
45 Minutes Pointe Per Week

$70 Monthly
$60 Monthly

Discounts

★3+ Hours 10%

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 last day or the 1st of the month of September-June. 30 days written notice must be given to request auto payment to be terminated. Any tuition that has not been paid by the 15th of each month will have a late fee of $25. 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 I will immediately notify Velocity Dance Company if the card provided is no longer valid and will provide a new alternative payment.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.
Velocity Dance Company takes the utmost care of all students during class, however, there are possibilities of an accident occurring. In order to deal with any type of emergency, we require all parents or guardian to sign this consent and emergency release form.

I certify that my child is in proper physical condition to take part in any dance activities Velocity Dance Company Inc., offers. I realize there are certain risks that might happen when dancing. I agree to assume the risk of all injuries, illnesses, or damages that may arise from my child’s participation in the dance activities of Velocity Dance Company Inc.
I hereby release and hold harmless Velocity Dance Company Inc., their teachers and directors from and against any liability or claim for any loss of property, misadventure, harm, cost or damage sustained as a result of my child’s participation in Velocity Dance Company Inc., classes and activities.

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

Registration Form