Broadway Bound Dance Center
2009/2010 Registration Form
Mail to: Broadway Bound Dance Center, 17 Willow St., Natick MA 01760
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Student’s Name:
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Age: Date of Birth: Grade:
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Address:
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City: State: Zip:
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Emergency Contact: Relation:
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Emergency Phone Number: Medical Information:
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Parent #1: Phones: (H) (C/W)
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Parent #2: Phones: (H) (C/W)
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Family e-mail: Student e-mail:
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Class Fee’s Per Semester (Circle below): Fall Semester (9/8/09 to 1/30/10)
Spring Semester (2/1/10 – 6/19/10)
Recreational: One Class - $280 Two Classes - $500 Three Classes - $680
Team: 4 Classes - $725 Additional Classes - $175
Core Company: All (6 hrs) - $1,050 Additional hrs/classes - $170
Workshops: Musical Theatre - $175 Nutcracker (Nuts N Bolts) - $175
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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: ____________________________
Class: ___________________________ Day/Time: ____________________________
Total Semester Cost: _________________
** Payment in full due with registration form – Checks payable to BBDC **
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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:________
