REGISTRATION

Baker School of Dance Registration Form

Date:________________

Student Name__________________________________Birthdate___________________
Parents
Names_______________________________________Home phone_______________
Mailing
Address___________________________ __Zip________Cell phone______________
Billing
Address__________________________________Emergency Phone___________

E-Mail Address:______________________________________________________________________

Class(es)
Enrolled_________________________________________________Cost/month

__________________________________________________________________________________________________________________________

Child #2
Name____________________________________________________Birthdate___________________
Students

Class(es)
Enrolled_________________________________________________Cost/month

__________________________________________________________________________________________________________________________
Child #3
Name____________________________________________________Birthdate___________________
Students

Class(es)
Enrolled__________________________________________________Cost/month______________

Please charge my : Mastercard Visa (circle one) on the first week of the month for Monthly charges. I will pay for costumes separately. Card #____________________________Exp._________________________________________________________________________

I have read the rules of the school and have gone over them with my child(ren). I understand that classes are billed on a monthly basis, due the first week of the month even if I do not receive my statement on time. I will notify the studio in writing if my child stops attending classes. My child will respect classmates and instructors. I will not hold the Baker School of Dance or any of it’s instructors responsible for any injury to my child while in class or while waiting for class, and understand that if my child is disrespectful or misbehaves that s(he) will be removed from class.

Parent
Signature_____________________________________Reg. Fee enclosed
Please mail to: Lisa Simmons, 37 Monroe St., Buzzards Bay, MA 02532