Hoboken Dance Academy Registration Form                                            

                                                                                      

 

                                                                                          

 

Students Name______________________________________________________________

Parents Name_______________________________________________________________

Address____________________________________________________________________

Home Phone__________________ Mobile_________________ Work__________________

E-mail__________________________________________Birthday_____________________

Emergency Contact___________________________________________________________

Things we should know about your child__________________________________________

___________________________________________________________________________

 

Release of liability: I, as the legal parent or guardian of the above student,
Authorize his/her enrollment in the above classes and release the Hoboken
Dance Academy, LLC of all liability due to personal injury or loss of property.

 

Signature_____________________________________ Date_______________

 

Payment Worksheet and Class Choice

Class Name Day Time

1.______________________________________________________________

2.______________________________________________________________

3.______________________________________________________________

4.______________________________________________________________

5.______________________________________________________________

 

Payment Number________     

 

Tuition per month _______

Registration fee $25.00
Discount if applicable ______ (HFA Members 20% discount and 10% Sibiling discount)

TOTAL _______

Please choose method of payment:
CHECK CASH VISA MASTERCARD

 

CC#___________________________Exp. Date_____________________________

 

Signature____________________________________________________________

 

Check Number____________________