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[
1122 Pleasant St. — Worcester, MA 01602 — 508.753.6110
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Worcester |
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[ Westmeadow
Plaza — Westboro, MA 01581 — 508.366.8961 ]
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Westboro
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:: CKDC
STUDENT ENROLLMENT FORM ··
2008-2009::
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Please PRINT
the info requested below and bring or mail it to the Worcester
or Westboro studio with payment of $25.00
Registration Fee for each
student registering. For further info or to request add'l forms,
call the studio at 508.753.6110.
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Student's
name______________________________________________Age:______
Birth Date
_____/ _____/ _____/
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| Street
Address_____________________________________________________________________________________ |
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Town
/ City___________________________________________________State________
Zip_____________________
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| Home
phone__________________________________ Parent's
daytime phone_________________________________ |
| Parent's
cell phone___________________________________Student's
cell phone________________________________ |
| Parent's
email____________________________________ Student's
email______________________________________ |
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| Please
indicate: [ if you require add'l space,
please use the back of the form ] |
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Public
/ Private school and grade student attends____________________________________________________
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Please
inform us of any food allergies or any other medical problems that you
want the teachers to know about. |
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Previous
Dance Training [ new students only ] |
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Where?____________________________________________________________________________
Years______
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Subjects:
Ballet________
Jazz________
Tap________
other______________________
Hours per week________
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| Name
of person responsible for account [ Please Print
] __________________________________________________ |
| Address
[ if different than student's ] __________________________________________________________________ |
| Phone
[ if different than student's ] ___________________________________________________________________ |
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[ Class information
below will be completed by the studio office at time of registration
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SUBJECT / LEVEL
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DAY / TIME / STUDIO
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CLASS HOURS
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Total
class hours listed _________ First
tuition payment due __________ |
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I have read the general
information sheet and agree to the studio policies
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| Parent's
Signature ___________________________________________________
Date __________________________ |
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[
for office use ]: Amount: $ ________________ CASH
- MC / VISA - AMEX - DISCOVER - Check No. ____________ |
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