All The Right Moves Fall Registration 2007-2008

Student Information:

Student Name _____________________________DOB ____________ Age _______

Address _____________________________________________

City/State/Zip _____________________________Phone # ____________________

Current School ____________________________ Grade ______

Dance Experience (# yrs. and where) ____________________________________

Mother’s Name ____________________________

Cell # _____________________________________ Work # ______________________

Father’s Name _____________________________

Cell # ___________________ Work # ______________________

Billing Information:

Billing Name ___________________________ Address _______________________________

City/State/Zip __________________________ Email __________________________________

Medical Information:

Dr. Name _________________________ Phone# _____________________

Emergency Contact ________________ Phone# _____________________

Health Conditions ______________________________________________________

Current Medications ____________________________________________________

Classes:

Name of Class Day Time

1._____________________________________________________________

2._____________________________________________________________

3._____________________________________________________________

4._____________________________________________________________

5._____________________________________________________________

6._____________________________________________________________

7._____________________________________________________________

8._____________________________________________________________

Fees: DUE UPON REGISTRATION…WITH THIS FORM

**HAVE YOUR MONTHLY TUITION AUTOMATICALLY CHARGED TO YOUR CREDIT CARD/DEBIT CARD AND NEVER HAVE TO WORRY ABOUT LATE FEES!! (INQUIRE IN OFFICE)

Registration (new $15/student or $30/family) $________

*returning students are FREE!!

Monthly (due 1^st of every month) $________

Trimester (5% discount) $________

Year-In-Full (10% discount) $________

TOTAL FEES TODAY $________

Check#________ Cash______ Visa_______ M/C______ Discover______ Amex_____

**RETURNED CHECK FEE- $25 **TUITION IS LATE AFTER 10^TH OF EVERY MONTH-FEE $15

How did you hear about us?

word of mouth flyer/ magazine/newspaper drove by website

Who referred you to ATRM? ___________________________ ($15 credit to their account)

Hold Harmless Agreement

I understand that ATRM, LLC and it’s principles, faculty, and volunteers are not liable for any injuries that may occur while my son, daughter, myself or other family members are involved with lessons or other ATRM related activities, and hereby release, indemnify and agree to hold harmless ATRM Dance Company and it’s principles, faculty and volunteers from any claims or expenses resulting from or arising out of the participation of my son, daughter, myself or other family members in any such activities or events.

Signed _____________________________________ Date ___________________

(parent/legal guardian)

Thank you for choosing ALL The Right Moves Dance Company!!