the PDF - Adair Dance Academy

Adair Dance Academy
Home of the One-Hour Recital!
Registration Form
Mail one month’s payment with completed form to:
Adair Dance Academy
1006 N 127 Circle
Omaha, NE 68154
Please call 551-4200 now to reserve your space!
Today’s date _________ Student’s name ___________________________ Date of birth _____________ Age _____
Parent or guardian’s name _________________________________________________________________________
Phone: Home ______________ Work/cell _________________ Address _____________________________________
City, state, zip ____________________________________________
Email _________________________________________ School ___________________________________________
Are there any health issues Adair Dance Academy should be aware of? These may include injuries, asthma, diabetes,
food or medicine allergies, ADHD, dyslexia, and others. If so, please indicate below:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Other medical information: Required medications/inhalers, special instructions, other. Please discuss these with the
teacher and update information if there are changes.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
To be signed by parent or guardian: In the event that I am not available, I give my permission to Adair Dance Academy
to provide first aid for the child named above and to take appropriate measures, including contacting emergency medical
services. I understand that at no time will Adair Dance Academy faculty drive an ill or injured student to an emergency
facility.
Signature and date
_________________________________________________________________________________________________
Class
Day
Time
Location
Fee
__________________ __________________ __________________ _________________ ________________
__________________ __________________ __________________ _________________ ________________
__________________ __________________ __________________ _________________ ________________
__________________ __________________ __________________ _________________ ________________
Total ___________
Alternate Class Selection ____________________________________________________________________
(ADA will register you for your alternate class selection if one of your primary class selections should already be filled.
Dancers in Grades II, III, IV and V are required to take a minimum of two classes per week.)
Please tell us how you heard about Adair Dance Academy and why you have chosen our studio.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Adair Dance Academy Payment Policy
1. A non refundable deposit will hold your space in a class and serve as your September tuition payment. (After you pay the deposit, you will owe 7 more
payments – October through April.) Class spaces are on a first come, first served basis, so please respond promptly.
2. Performance fees are included with tuition, and tuition must be paid in full at the beginning of each month. A late fee of $10 will be assessed if a
monthly payment is not made by the 12th of the month. This fees increases to $25 per month after performances; accounts are forwarded to collections
after 3 months of nonpayment. A $20 fee is assessed for each returned check.
3. Multi-student discounts: For families with two or more students enrolled, take $4 off monthly tuition for Pre-ballet and $5 off for Primary or Grade I
classes. Grade II, III, IV and V multiple class/family discounts have already been applied.
4. Registration for a class obligates you to pay tuition for that class in full; there are no refunds. Deposits are nonrefundable. Injured students are
encouraged to observe classes, especially during performance season; no fee adjustments will be made for missed classes. Students enrolled in
classes are obligated to participate in performances. Those unable to participate must notify their teachers no later than January 1 st; however, this does
not entitle the student to any refund.
5. The ADA Web site policy page provides a complete listing of all ADA policies and is updated regularly. ADA will send information to you via e-mail
regularly. Your signature on this form indicates that you are aware of and agree to all ADA policies.
I understand and agree to abide by these policies. Date __________________________________________________
Signature ______________________________________________________________________________________
Dance Academy Multimedia Release
I understand that students may be photographed, videotaped and audio-recorded during his/her attendance at Adair Dance Academy. These items may
appear on the studio Web site, in photo display cases and for other related promotions. Please place an "X" in the appropriate place, and sign
below.____ Yes, I give permission for my child to appear in photos, videos and recordings on the school website. ___ No, my child may not be
photographed or recorded.
Signature ______________________________________________________________________________________