Broadway Bound Dance Center

2010/2011 Registration Form

Mail to: Broadway Bound Dance Center, 17 Willow Street, Natick, MA 01760

Student's Name:

DOB: Age: Grade:

Address:

City: State: Zip:

Parent #1: Phone (H): (C):

Parent #2: Phone (H): (C):

Family Email: Student Email:

Emergency Contact: Relation:

Emergency Phone Number: Medical Information:

PAYMENT PER SEMESTER: Fall Semester 9/7/09 to 1/8/11 & Spring Semester 1/10/11 to 6/10/11
(Automatic enrollment for Spring)

Recreational - Pricing

Team - Pricing

Core – Pricing

(White classes and **Team classes if approved)

(Team Classes & White Classes)

(All Core, Team & White Classes)

One Class - $285 per semester

Team (4 hrs) - $750 per semester

Core (6 hrs) - $1100 per semester

Two Classes - $510 per semester

Team (5 hrs) - $925 per semester

Core (7 hrs) - $1275 per semester

Three Classes - $700 per semester

Pointe (1.5 hrs) - $260

Core (8 hrs) - $1425 per semester

*Wait list for team classes until July 21^st

* Additional classes $175 per class

*Additional classes $175 per class

Please Fill out Class Name, Day/Time & Total Cost below:

Class: _______________________________________ Day/Time: ________________________________________

Total Semester Cost: _________________

** Payment in full due with registration form – Checks payable to BBDC **

Email us at support@bbdcnatick.com with questions

_______________________________________________________________________________________________

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: ________________