REGISTRATION

Student Name___________________________________Age(as of 1st day of class)
___DOB___________

Address___________________________________________________City______
________Zip________

Home Ph#______________    Email___________________________________

PARENT/GUARDIAN/BILLING INFORMATION

Mother’s Name____________________________    Work
Ph#_________________Cell#_____________

Father’ Name______________________________   Work
Ph#_________________Cell#_____________

PLEASE INDICATE ALL AREAS OF INTEREST

Ballet__Tap__Jazz__Hip-Hop__Modern__Lyrical__Point__Pre-dance (ages 3-5)__  
Ballroom__Acting/Musical Theatre__Karate__Instrumental__

HOW DID YOU HEAR ABOUT US?  Website__Yellow Pages___Radio__Brochure/Media__

Referral__ if so, who?  _____________  Other_______________________

I, _________________________, being the consenting adult(s), parent(s), or legal guardian
of ___________________________allow my child to participate in classes at The NC School
of Performing Arts.  I understand that I am responsible for all tuition payments, production, and
costume fees.  I agree to  pay a $25 service fee as a result of any payment returned to The NC
School of Performing Arts for insufficient funds.

Forms of payment for monthly tuition:

1.  Monthly bank draft from checking account

2.  Tuition paid in full for the semester by check or cash

Refunds are given pending a 30 day written termination notice.

We strive to provide the maximum in safety procedures and cannot assume responsibility for any
injuries or accidents that may occur.  Like any physical activity, participation in dance does involve
a certain amount of risk or injury.  By permitting this student to participate, the undersigned
acknowledges that they are fully aware of that risk and hereby releases The NC School of
Performing Arts from all claims, expenses, and any legal action arising from their or their minor
child’s participation in the dance program offered by The NC School of Performing Arts.

I have read and received the attached  statement of policies and agree to all the policies, procedures,
rules and dress code requirements established by The NC School of Performing Arts.

Signature_____________________________________        
Date______________________________

This form also serves as a release  form for the use of  pictures, video presentations, promotions,
media, television and the likes.  Your signature releases all rights for use of our material.  We do
not list names with photos.

Student/Parent or Guardian
Signature________________________Date_________________________