Enrollment form – MoonLite Dance Studio

Moonlite Dance Studio

Contact Information

Student(s) Last Name

Primary Contact

Relationship to Student

Address

City

Zip

Email

Phone

Work Phone

Secondary Contact

Relationship to Student

Address

City

Zip

Email

Phone

Work Phone

Student Information

Student #1 Name

Age

Date of Birth

Gender

F

M

Cell Phone

School

Other Information (Allergies, Disabilities, Medication, ECT)

Select Classes

Ballet

Jazz

Lyrical

Hip Hop

Tumbling

Combo

Tap

Pom

Modern

Student #2 Name
Age		Date of Birth		Gender	F M
Cell Phone
School
Other Information (Allergies, Disabilities, Medication, ECT)

Select Classes
Ballet	Jazz	Lyrical	Hip Hop	Tumbling	Combo
Tap		Pom		Modern

Select Classes

Student #3 Name
Age		Date of Birth		Gender	F M
Cell Phone
School
Other Information (Allergies, Disabilities, Medication, ECT)

Ballet	Jazz	Lyrical	Hip Hop	Tumbling	Combo
Tap		Pom		Modern

Moonlite Dance, LLC. is hereby granter premission to take a photograph OR video of the student(s) to use for any advertising material inclouding the website, social media, print media, ext.
Policies and Late Tuition: I have read and understand all articals presented in the policy form. I understand that tuition paid after the 10th of the month will incur a $15.00 late fee, as all feed not paid by the deadline. I also understand that an additional late fee will be applied to my account if there is an unpaied balance at the end of December. Costumes will only be handed out ans students will be allowed to perform once all tuition and fees are paid. I have read and agree to these terms.
Care of Students, illnesses and injuries: Moonlite Dance, LLC. is instructors and assistancts are not responsible for providing before or after care for students. Parents with children under the age of 6 must stay with the child untill class begins and pick up the child instde the building when class is over.Students are not to be left at the school for excessive timer before or after class. Parents, Legal guardians of minor students or adult students hereby wave the right to and leagalaction from normal dance activity or any other activity conducted before, during, or after class time. I have read and agree with these terms.
YES NO Administration of OCT Medicine:: My child has my permission to request OTC medication for injury or illness from Moonlite Dance Staff (Ages 12+ only)