Chatham Dance Connection
ReGISTRATION FORM 2017/2018
Name: ______
Address: ______
Phone: ______Date of Birth: ______Age: ______
Student’s School: ______Grade Level: ______
Student’s Doctor: ______Phone: ______
Parents Name(s): ______
Work Phone: ______Cell Phone: ______
Email: ______
Emergency Contact: ______
Phone: ______Alternate Phone: ______
It is understood that in the event the above named student needs emergency medical care, “Chatham Dance Connection” will contact parent/guardian or individual listed for instructions. If neither can be reached, I authorize “Chatham Dance Connection” to contact the medical professionals listed or others if necessary and take appropriate action. I also acknowledge that the above named student will be dancing at his/her own risk and will assume responsibility for his/her actions while attending “Chatham Dance Connection” classes or performances.
Parent Signature: ______
Date Signed: ______
I give “Chatham Dance Connection” my release to use photos and videos of myself and/or my child/children obtained during classes and performances for promotional print and/or website promotions for “Chatham Dance Connection.”
Parent Signature: ______
Date Signed: ______
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In the event that the above named student decides to withdraw from class, I will provide Chatham Dance Connection with two week’s written notice. Tuition for the current month is still due. I understand that upon withdrawal, all tuition and registration fees are NON-REFUNDABLE.
Parent Signature: ______
Date Signed: ______
*Please list all classes that you wish to enroll in on the back of this form.*
Phone: (919)542-1882 or (910)540-8679
Physical Address: 352 East Street, Pittsboro, NC 27312 ~ Mailing Address: 40 Milliken Rd., Pittsboro, NC 27312
Website: www.chathamdanceconnection.com ~ Email:
Chatham Dance Connection
“Get connected to DANCE!”
Please list all classes in which you are enrolling, including day and time.
1. ______
2. ______
3. ______
4. ______
5. ______
6. ______
*A non-refundable costume fee of $65 per costume is required for all students who are participating in the annual recital on Saturday, June 2, 2018. Your non-refundable costume deposit of $35 is due upon registration. The full costume balance is due by December 14, 2017 to ensure that your child receives a costume. If you enroll after January 1, 2018, be sure to ask your teacher about purchasing a costume. It will need to be purchased as soon as possible to ensure that the costume arrives before recital day. If your costume fee isn’t paid by December 14, 2017, your child is not guaranteed a costume for the recital and may not have a costume for our picture day.
*Tuition is based on a 4 week month. Some months there will be either more or less than 4 weeks of class. It will balance out in the end. Therefore, tuition WILL NOT be pro-rated. Please note that there will be additional fees as we approach recital time in the spring (recital fee, t-shirt fee, etc.).
MONTHLY TUITION AUGUST 2017-MAY 2018
Registration Fee: $20.00 per child before July 27, 2017 - $25.00 after July 27, 2017
30 min. per week = $40/month 1hr 45min. per week = $85/month 3hr per week = $135/month
45min. per week = $48/month 2hr per week = $95/month More than 3hr per week = $150/month
1hr. per week = $55/month 2hr 15min. per week = $105/month Mini/Youth Company = $20/month
1hr 15min. per week = $65/month 2hr 30min. per week = $115/month Jr. & Sr. Comp. + Tech = $35/month
1hr 30min. per week = $75/month 2hr 45min. per week = $125/month
*Private Lessons - Vary by teacher/session
*Single Drop-In Classes = $10 per half hour class/ $12 per 45 min class/$15 per hour class
*Recital Fee = $35 per student (Due March 15, 2018) - includes 2 recital tickets and 1 recital t-shirt
(The recital fee is NOT the same as the costume fee. This is an additional fee required for participation in the June recital.)
*Sibling Discount 10% off tuition for second child. *Returned Check Fee = $25 per returned check
*Please add up the fees for each class that you/your child are taking and write the total amount here: $______._____. This is your monthly tuition. This amount is due by the 1st day of each month, not the first class of the month. After the 10th day of the month, you will be charged a $15 late fee if tuition is not rendered. If fees are not paid by the end of the current dance month, dancers will not be allowed to resume class until payment is received in full. THANK YOU!
Tuition will ONLY be pro-rated for the month of August. Full monthly tuition will be expected September-May. Please drop your tuition payments in the drop box just inside the studio door. Cash payments must be in a sealed envelope with the child’s name on the front of the envelope. If you need a receipt, please leave a note with your payment and a receipt will be provided for you at your child’s next scheduled class.