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BACKSTAGE DANCE STUDIO

7185 Columbia Gateway Drive, Columbia, MD 21046 410-312-0900 (phone) ~ 410-872-9972 (fax)
www.TheBackstageDanceStudio.com (web) ~ info@TheBackstageDanceStudio.com (email)

2011-2012 REGISTRATION FORM
Classes Begin Tuesday September 6, 2011

REGISTER BY JULY 9, 2011 and RECEIVE 50% OFF REGISTRATION FEE!
Student Name: _________________________________________________________

Phone: ______________________________

D.O.B._____________________ Age: ____________
Address: _______________________________________________________ City: _______________________

Zip: ___________

Adult’s Name: ____________________________________________ Relationship to Student: ________________________________
Work #: _____________________________________________ Cell #: __________________________________________________
Adult’s Name: ____________________________________________ Relationship to Student: ________________________________
Work #: _____________________________________________ Cell #: __________________________________________________
**Email Address (required): __________________________________________________________________ (one email per family)
(ALL communication will be made through this email address)

DAY(S)

TIME(S)

BALLET

: _____________________________________________________________________

POINTE

: _____________________________________________________________________

JAZZ

: _____________________________________________________________________

MODERN

: _____________________________________________________________________

LYRICAL

: _____________________________________________________________________

TAP

: _____________________________________________________________________

HIP-HOP

: _____________________________________________________________________

ROCKIN’ TOTS

: _____________________________________________________________________

All Lyrical students must be enrolled in at least one ballet class. All Pointe students must be enrolled in at least two ballet classes.
Tuition is broken into 5 equal payments with the first tuition payment due at time of registration along with a $25.00 registration fee per
student ($10.00 for each additional family member). Registration fees are non-refundable and non-transferable. Registrations are
taken throughout the summer, and classes will be filled on a first come, first served basis. Tuition is also non-refundable and nontransferable once a tuition period has started. Please mail this form with your first payment and registration fee, and a place will be
reserved for you in the selected classes. You may also fax your registration form to the studio with your credit card information.
Your signature on the registration forms constitutes an agreement with Backstage Dance Studio, and demonstrates that you have read
and understand our studio and tuition policies.
It is the responsibility of the parents to read through and agree to all studio policies which can be found on our website.
I have read and understand the Studio & Tuition Policies of Backstage Dance Studio.
PARENT/LEGAL GUARDIAN SIGNATURE

___________________________________________________

DATE

__________________
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50 30 min class 45 min class 1 hour class ROCKIN’ TOTS SESSIONS: Fall Session: Winter Session: Spring Session: 9/10/11 – 12/3/11 (12 week session) 1/7/12 – 2/25/12 (8 week session) 3/3/12 – 5/19/12 (12 week session) Tuition: $153. Suite J Columbia.00 There will be a $10 registration fee for your Rockin’Tots session of the year.2011-2012 TUITION – 5 EQUAL PAYMENTS $65. Referred student must remain in class for two months in order for referring student to receive the credit.50 $127. CREDIT CARD PAYMENT: VISA______ MasterCard______ Discover______ Name of Cardholder: _____________________________________________________________ Card #: _____________________________________________________________ Exp.00 Tuition: $153. Tuition discounts do not apply to Rockin’ Tots 2011-2012 DISCOUNT RATES: 3 classes 4-5 classes 6-7 classes 8 or more classes 3% off entire tuition 5% off entire tuition 8% off entire tuition 11% off entire tuition Pay tuition in full for the entire year at time of registration. good towards tuition. and receive an additional 5% off! First Tuition Payment $__________________________________ Discount % for Multiple Classes $__________________________________ Discount 5% for 1 Year Payment in Full (Cash or Check ONLY) $__________________________________ Registration Fee ($25/$10 each additional sibling) $__________________________________ Total Amount Due $__________________________________ Refer a non-sibling friend and receive a $15.00 Tuition: $103. MD 21046 FAX # 410-872-9972 Make checks payable to BACKSTAGE DANCE STUDIO. Date: _______________ CVC#: ______________________ (3-digit number on back of card near signature strip) Cardholder Signature: _____________________________________________________________ Page 2 of 2 .00 credit. Please mail or fax all pages of this registration form with your payment to: Backstage Dance Studio 7185 Columbia Gateway Drive.75 $96.