Nicole Cote School of Dance Registration Form 2010-2011
SUBMIT WITH REGISTRATION FEE TO THE STUDIO OR
MAIL TO: 5872 GOLDRUSH AVE, GRANT FL 32949
To open the registration form
as a printable .pdf file, please
click here
Classes Begin Monday August 16, 2010
Dancer's name: ________________________________________
Age: ________
Dancer's date of birth: ___________________ Home telephone: ________________ Cell _______________
Email address: _____________________________________________________
Parent or Guardian Name: _________________________________________________
Guardian's Relationship to Dancer: : _________________________________________________
Dancer's Address: (street) ____________________________________
City: _____________ Zip: ___________
Payment Plan you are choosing (please
circle one):
( ) One Lump Sum Payment for the year with
5% discount (discount only applies to those registering in August 2010)
OR
( ) Monthly Payment Plan (due at the first
of every month)
Monthly tuition will be: (please fill in) $___________
(I understand that Nicole Cote School of Dance charges a fiscal school year rate and is allowing me to pay this yearly rate is monthly installments. Payments are expected each month as long as my child continues throughout the entire school year. Monthly payments are for my convenience only and must be placed in the tuition box located in the studio lobby. I am responsible for knowing when my payment is due and I realize that I am subject to a $20.00 late fee if my payment is not in by the 5th of each month.)
( ) Please check this box and sign below
to acknowledge that you have read and agree to all of the studio's policies.
(Payer's signature)____________________________________________
Date_________________________
CLASSES YOU ARE REGISTERING FOR (please use separate sheet of paper if needed):
Class Name:Class
Day:
Class Time:A
or B
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