Broadway Bound Dance Center
2011/2012 Registration Form
Mail to: Broadway Bound Dance Center, 17 Willow Street, Natick, MA 01760
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Student's Name:
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Date of Birth:
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Age:
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Grade (Fall 2011):
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Address:
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City:
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State:
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Zip:
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Parent #1:
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Phone (H):
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(C/W):
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Parent #2:
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Phone (H):
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(C/W):
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Emergency Contact:
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Relation:
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Emergency Phone Number:
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Any medical conditions we should be aware of:
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**Updated Email (best communication): ____________________________________________________________________
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I give permission to release my email to the program my child is enrolled in for group contact
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I do not give permission to release my email but would like to be on the mailing list for important studio information
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Cost Per Semester
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Fall Semester 9/6/11 to 1/14/12 & Spring Semester 1/17/12 to 6/9/12 (Automatic enrollment for Spring)
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Number of Classes/Hours Per Week
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1
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2
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3
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4
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5
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6
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7
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8
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Additional
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Recreational (white classes)
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$285
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$510
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$700
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Team (colored classes)
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$750
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$925
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$1,100
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$1,275
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$1,450
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$175
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Core (gray classes)
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$1,100
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$1,275
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$1,450
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$175
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NEW! Musical Theater
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$350
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Please Fill out Class Name, Day/Time & Total Cost below:
Class: _____________________________________ Day/Time: ________________________________________
Class: _____________________________________ Day/Time: ________________________________________
Class: _____________________________________ Day/Time: ________________________________________
Class: _____________________________________ Day/Time: ________________________________________
Class: _____________________________________ Day/Time: ________________________________________
Class: _____________________________________ Day/Time: ________________________________________
Class: _____________________________________ Day/Time: ________________________________________
Class: _____________________________________ Day/Time: ________________________________________
Total Semester Cost: _________________
** Payment in full due with registration form – Checks payable to BBDC **
Email us at support@bbdcnatick.comwith questions
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I, the undersigned Parent or Guardian of the above student, release BROADWAY BOUND DANCE CENTER, including instructors and assistants, from any and all injuries which may occur from training, practicing, performing and/or during any event or activity. I also agree that I am responsible for the health and accident insurance and any medical costs for the above student incurred due to injury including, but not limited to, emergency medical transportation and treatment if the need arises. I understand that BBDC has a NO REFUND policy. If a student drops, the account will be credited the remaining balance and will be saved for up to one year. I also give my permission for the public display of any studio pictures that my child may be in.
Print Name: ______________________________ Signature: ________________________________ Date: _______________
