Miss Mona's School of Dance & Performing Arts

Miss Mona's School of Dance & Performing Arts

Student Registration Form

154 West 4th St.

Salem, VA

(540) 387-9575

Student's Name ______Date ______

Parents' Names ______

Address ______

City______State ______Zip ______

Home Phone______Parents’ email (required) ______

Birth Date ______School ______Grade ______

Mother's Employer ______Cell Phone ______

Work Phone ______SS# ______

Father's Employer ______Cell Phone ______

Work Phone ______SS# ______

How did you hear about Miss Mona’s? ______

______

Previous Dance Training?YesNo"If yes, where?"______

Previous Student at Miss Mona's?YesNoIf yes, when?" ______

Is there any day or time that you cannot attend class? ______

If another party is to be contacted regarding your financial statement, please list their name, phone #, and email address here:

______

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CONSENT AND INSURANCE

I have read the rules and regulations listed on the attached page and I understand and agree to all terms and conditions.

INSURANCE WAIVER

I agree that I will not hold Miss Mona's School of Dance & Performing Arts, its faculty, staff or its landlordliable for any illnesses or injuries that occur while attending dance classes, nor will they be responsible for loss or damage to personal property.

Signature of BOTH Parents/Guardians ______Date ______

______Date ______

Please initial that you have received:

_____ Student handbook _____Recital Handbook ______

POLICIES- please keep for your records

ABSOLUTELY NO FOOD OR DRINK IS ALLOWED IN THE STUDIO. ONLY WATER FOR DANCERS.

REGISTRATION FEE

A $15.00 fee is required with the registration form to reserve class space. The registration is not considered complete until this fee is paid. This fee is non refundable.

REFUNDS

Refunds are only given due to serious illness or surgery, or when a student has moved out of state.After the first or second class, if the instructor feels that a beginner student is not ready to participate in class we will also give a partial refund, but this rarely happens. We will give prorated refunds if a family is moving out of state. Refunds are not given just because the student no longer wants to take classes.

You will continue to be charged tuition, costumes, and all applicable fees until a written notice of withdrawal from classes is received by our office.

COMMUNICATION______

Miss Mona’s provides information through monthly newsletters, occasional handouts, notices on the bulletin board, scheduled parents’ meetings, and our website. Occasionally we will send information via email as well. Parents are responsible for being sure they are receiving all information by picking up monthly newsletters from the studio office each month. We cannot be responsible for parents missing information that has been distributed in one of the above ways, so please be diligent about staying informed of studio activities, fees, and due dates.

TUITION

Tuition for each month will be due before the 10th of each month. Tuition remains the same whetherit is a standard month, a 5 week month, or a 3 week month, and regardless of absences. Studio closings will be noted on our website, or announced ahead of time.YOUR CHILD’S NAME MUST BE ON THE CHECK TO INSURE IT IS CREDITED PROPERLY.

LATE CHARGES

A compounded late charge of $15.00 per month is strictly enforced.Lesson money is due BY THE10th OF EACH MONTH. There will be absolutely no exception to this rule. Late Charges will be assessed every month the outstanding balance remains due. Late charge for December and May is $25. No exceptions.

If it is necessary for the account to be referred to an attorney for collection there will be attorneyfees of thirty-three and one-third percent (33 1/3%) of the unpaid balance plus all court costs. Late charges will be added to costume and recital payments as well.

RETURNED CHECKS

There will be a service charge for $45.00 on all returned checks

SAFETY

Please be prompt in picking up your child after class. Students are not allowed to leave the schoolpremises unless picked up by a parent. All students are to stay inside the studio.Parents of Tiny Tots and Preschool need to be inside the studio 10 minutes before the end of class.

PICTURE RELEASE

Miss Mona's School of Dance and Performing Arts has my permission to use my child’s picture foradvertising and publicity purposes unless otherwise noted on this form.

RECITAL

Our recital is held in May and the date is announced the previous fall. Please reserve that week now because your child will be involved in rehearsals that last week. All students are entitled and encouraged to be in recital, but it is not mandatory. NO ONE IS ALLOWEDTO MISS STAGE REHEARSALS FOR ANY REASON.Failure to attend will result in the student not being able to participate in the performance. Costumes are paid for by the students and furnished by the studio. A deposit is taken and the balance is paid for before the costumes are given out. Additional deposits on costumes can be made by you anytime during the dance session. If you are paying tuition or other charges at the same time you are making a costume deposit, please specify on you check the amount that is to be applied to the costumes. Costume deposits are NON REFUNDABLE. Our policy regarding recital fees and tickets will be discussed during parent meetings prior to recital. The recital fee is non refundable. A recital commitment slip will need to be signed by a parent or guardian for all children that will be participating in the recital. Once thecommitment slip has been signed you will be responsible for all of your outstanding recital balances including costumes and recital fees, even if your child does not participate in the recital.Your recital handbook and additional parents meeting will cover all information regarding recital and performances in detail.

INCLEMENT WEATHER

As we serve students from all parts of Roanoke, Craig, Franklin, Vinton, and Salem, in order to best consider their safety, Miss Mona’s will close if Roanoke County OR Salem schools close for bad weather. We do not close for teacher workdays, etc. Any other cancellations will be announced ahead of time, or listed on the studio calendar on our website. Please watch the local news for school cancellations if weather is questionable. After three classes are missed (in one year) for inclement weather, we will notify parents about a make-up class.

PARENT FINANCIAL RESPONSIBILITY

Due to problems we have encountered in the past, we are requiring the information from both parents to be listed on the registration forms from this point forward. Please note that this information will be kept private and confidential and will only be used in the event that a past due balance is not resolved by the responsible parties, requiring us to pursue collections.

If a third party is responsible for the financial obligations on your behalf, please supply them with any pertinent studio information and forms as well. We also will need to have the responsible party’s contact information in the event that we need to discuss an outstanding balance.

Contact Information:

Mailing Address:

Miss Mona’s

6424 Pendleton Ave

Roanoke, Va 24019

Phone:

(540) 387-9575

Website:

Email: