Broadway Bound Dance Center

2008/2009 Registration Form

Print & Mail  to: Broadway Bound Dance Center, 17 Willow St., Natick MA 01760

Student’s Name:

Age:                                 Date of Birth:                         Grade:

Address:

City:                                           State:                              Zip:

Emergency Contact:                                                   Relation:

Emergency Phone:                                     Medical Information:

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

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

Family e-mail:                                                    Student e-mail:

 

Total Cost  Per Semester (Circle below): Fall  (9/2/08 - 1/24/09) & Spring  (1/26/09 – 6/15/09)

Recreational:  One Class - $275               Two Classes - $490              Three Classes - $685

Team:    Pink (4 Classes) - $710    Purple (4 Classes) - $710          Blue (4 Classes) - $710

     Yellow (4 Classes) - $710    Green (4 Classes) - $710      Additional Classes - $175

Core Company:   Core plus 2 classes (Min. 6hrs wk) - $1,030    Additional hrs/classes - $170

Workshops:  Nutcracker (Nuts N Bolts) - $150   Musical Theatre - $150    

 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: __________________                                                                                   Fall Semester Cost:  _____________    Email us at support@bbdcnatick.com with questions   Please make checks payable to Broadway Bound Dance Center

 

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 also give my permission for the public display of any studio pictures that my child may be in.

Print Name:________________________________ Signature:____________________________ Date:________