VOICE LESSON REGISTRATION FORM
PLEASE PRINT CLEARLY. THIS FORM MUST BE FILLED OUT COMPLETELY.
Parent or Legal Guardian’s Name: (last) ________________________________ (first) __________________________ Are you over age 18: _______
1) Child Name: (last) ______________________________ (first) _______________________ Age: ________ Date of birth: _________________
2) Child Name: (last) ______________________________ (first) _______________________ Age: ________ Date of birth: _________________
3) Child Name: (last) ______________________________ (first) _______________________ Age: ________ Date of birth: _________________
Address: ______________________________________________________Town:__________________________ St:_____ Zip ____________
There will be a $5. charge per phone call if we do not have your email address and we need to contact you.
Email address (Print clearly please):_________________________________________________________________________
Tele: (home) ________________________________________________ (cell)_____________________________________________________
work) _________________________________________________(Emergency _______________________________________________
Child # ______ Class: ______________________________________________ Day: __________________ Time: _____:_____ to _____:_____
Child # ______ Class: ______________________________________________ Day: __________________ Time: _____:_____ to _____:_____
Child # ______ Class: ______________________________________________ Day: __________________ Time: _____:_____ to _____:_____
Child # ______ Class: ______________________________________________ Day: __________________ Time: _____:_____ to _____:_____
Child # ______ Class: ______________________________________________ Day: __________________ Time: _____:_____ to _____:_____
Wendy Worth, doing business as The Academy of Dance Arts shall not be responsible or liable for any personal injury, property damage, or consequential damage which may be sustained by any student or any other person as the result of any act or omission of Wendy Worth, doing business as The Academy of Dance Arts or any of the agents, servants, employees, or instructors on the premises of The Academy of Dance Arts or otherwise.
VOICE LESSON COMMITMENT:
Students need to sign up and pay for lessons by the month. If you cancel a lesson you will still need to pay for it unless we can fill the spot. If you wish to discontinue lessons you need to let us know a week prior to your last lesson. Thank you.
Tuition fees are due the 1st of every month (with a grace period until the 7th day of the month). I agree to pay a $5.00 per WEEK, $20. per month late fee.
Wendy Worth, doing business as The Academy of Dance Arts, has my consent for all purposes and/or use of photographs of the above registered student(s) with or without the use of names.
My child does____ does not _____ have special needs. Please list anything medical or otherwise we should know on the back of this form.
I understand and agree to this commitment.
X________________________________________________ Date: __________________
Signature of student, 18 yrs. or older, and/or parent or legal guardian
Signature of Witness: _______________________________
Print Name: ______________________________________ Phone #: _______________________________________
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