PARENT’S NAME / First Name Last name
ADDRESS: / Street address, city and province /
EMAIL ADDRESS: / Email address /
POSTAL CODE: / A1B 2C3. /
PHONE: / Home phone. Work phone.
STUDENT AGE: / Click here to enter age. /
BIRTHDATE: / Click here to enter date (M/DD/YYYY) /
SPECIFY LESSONS: / Click here to enter lesson #1Click here to enter lesson #2
Click here to enter lesson #3.
TOTAL FEE: / Total fee due /
FEES (H.S.T. NOT INCLUDED)
325.00 / 45 MINS CLASS / 3-8 YEARS
400.00 / 1 HOUR CLASS / 9 YEARS AND UP
480.00 / 1.25 HOUR CLASS / OLDER STUDENTS
515.00 / 1.5 HOUR CLASS / OLDER STUDENTS
615.00 / 2 HOUR CLASS / OLDER STUDENTS
PLEASE NOTE - DISCOUNTS APPLY TO THE LOWEST DANCE FEE
1. ANY STUDENT TAKING TWO LESSONS PER WEEK, OR TWO STUDENTS FROM ONE FAMILY
---15% DISCOUNT FOR 2nd LESSON
2. ANY STUDENT TAKING THREE LESSONS PER WEEK, OR ANY THREE FROM THE SAME FAMILY
---30% DISCOUNT FOR THREE LESSONS PLUS
PAYMENT OPTIONS:1. IN FULL BY CHEQUE, CASH OR DEBIT
2. WITH REGISTRATION AND BALANCE BY NOV. 30TH
3. QUARTERLY-PAYMENTS DUE SEPTEMBER- NOVEMBER -JANUARY-MARCH
4. MONTHLY
*****A $20 SERVICE FEE WILL BE ADDED TO ALL ACCOUNTS NOT PAID IN FULL BY NOV 30
PAYMENTS CAN BE MADE IN PERSON AT THE TIME OF FIRST LESSON, OR BY CHEQUE VIA CANADA POST.
PLEASE MAKE CHEQUES PAYABLE TO: / FAY GLEESON DANCE CENTREP.O BOX 28007
THUNDER BAY, ONTARIO P7E SM8
PLEASE NOTE: WE WILL NO LONGER ACCEPT VISA OR MASTERCARD PAYMENT
I AGREE TO ABIDE BY ALL THE RULES OF THE FAY GLEESON DANCE CENTRE. I FURTHER AGREE THAT I WILL NOT HOLD THE FAY GLEESON DANCE CENTRE OR ANY INSTRUCTOR OR ANY MEMBER OF THE FAY GLEESON DANCE CENTRE OR ANY FACILITY WHERE THE FAY GLEESON DANCE CENTRE INSTRUCTION IS GIVEN - IN ANY RESPONSIBLE FOR ANY INJURY THAT I MIGHT SUSTAIN AS A RESULT OF MY PARTICIPATION IN ANY OF THE FAY GLEESON DANCE CENTRE PROGRAMS.
DATE: / Click here to enter a date. /STUDENT SIGNATURE: / Print first and last name. /
PARENT SIGNATURE: / Print first and last name. /
☐ BY CHECKING THIS BOX, I CONFIRM THAT I UNDERSTAND AND CONSENT TO THE RULES AND TERMS ABOVE.
I ACKNOWLEDGE AND CONSENT TO ALLOW THE FAY GLEESON DANCE CENTRE TO USE PHOTOS AND/OR VIDEOS OF MY CHILD/MYSELF IN PUBLICATIONS AND ADVERTISEMENTS (SUCH NEWSPAPER ARTICLES, BROCHURES), OUR STUDIO WEBSITE OR SOCIAL MEDIA SITES (SUCH AS OUR STUDIO FACEBOOK OR INSTAGRAM ACCOUNT). I UNDERSTAND THERE WILL BE NO FINANCIAL COMPENSATION FOR THE USE OF ANY PHOTOS/VIDEOS.
☐ YES☐ NO
DATE: / Click here to enter a date. /SIGNATURE: / Please print first and last name /
☐ BY CHECKING THIS BOX, I CONFIRM THAT I UNDERSTAND AND CONSENT TO THE RULES AND TERMS ABOVE.