2014-15 fall registration form - San Antonio School for the

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2014-15 fall registration form - San Antonio School for the
STUDENT REGISTRATION
FORM
ESR________ Yes ____ No
CSR _______ Yes ____ No
Unlmtd _____ Yes ____ No
Note: ____________________
2015-2016
___
Student _______________________________________________Date Registering ___________________Year: _
Last
First
Birthday: _________________Age:_______
Address___________________________________________________________________________________________________
Street
Address
City
State
Zip
Phone _____________________________________________Emergency______________________________________________
Cell Phone ________________________________________ Other Phone _____________________________________________
Tuition Paid By_____________________________________________________________________________________________
Name
Address
City
State
Zip
Father__________________________________ Occupation __________________________Work Phone____________________
Mother__________________________________Occupation__________________________Work Phone____________________
E-mail address______________________________________________________________________________________________
EMERGENCY NUMBER __________________________________________Contact Person____________________________
How did you hear about SASPA?_______________________________________________________________________________
Number of months of formal dance training? ________________________Where?_______________________________________
If you are currently enrolled for dance instruction other than SASPA please list__________________________________________
Does the student have any serious medical or emotional problems we should be made aware of? YES NO Explain on back if needed.
If health is in question it is your responsibility to have physician’s consent to participate. Please list any and all medical issues on back.
ALL TUITION AND DEPOSITS ARE NON-REFUNDABLE
SASPA POLICIES, TUITION AGREEMENT AND LIABILITY AGREEMENT
(Please read carefully and initial)
______WAIVER AND RELEASE I recognize the risks of illness and injury inherent in any exercise, dance, music, art or theater program. Including, without limitation, broken bones; fatigue; sore, strained, or torn, muscles; strained or torn ligaments; swelling of tissue; and other conditions and/
or injuries. Nevertheless, student or, in the case of a minor or incapacitated student, Student’s parent or legal guardian, hereby acknowledge and
knowingly assume the risk of such conditions and /or injuries an d, to the maximum extent possible, release, waive, hold harmless, and forever discharge San Antonio School for the Performing Arts, Inc. its agents, contractors, employees, insurers, officers, representatives, heirs, successors and
assigns from any and all damages incurred by Student in Student’s participation in any class, program, or event (including, without limitation, any
injury sustained while practicing or warming up for such event.)
______END OF YEAR PERFORMANCE The yearly recital is for students to celebrate their achievements on stage in early June of each year. No
student can miss more than three combined classes or rehearsal between January and the performance. The participants in any SASPA event or program, shall be determined at SASPA’s discretion. Excessive absences affect the quality of a dance number and it is unfair to the teacher, the student
and the other students in the production.
______CONFIRMATION I have read and received a copy of the SASPA Policies and Tuition Agreement form. My signature indicates my understanding of school policies and their purpose to create a professional atmosphere through discipline. Discounted rates do not apply unless I pay an
annual registration fee and my tuition is paid by the 5th of each month in advance. This form is not complete without all applicable signatures.
______PAYMENT OPTION Tuition is paid in advance. Drop in students pay $25.00 per class. I understand the registered student tuition paywould not like to be placed on the automatic tuition payment system set up on my Visa,
ment options set forth on the website. I would
MC, Disc. or Am Ex. Tuition paid after the 5th of each month will be charged a late fee of $25.00. Office personnel will phone me regarding this
request for the protection of my information.
Visit our website at: saspa.org
_______________________________________________________
(Office will fill this section out)
_________________________________________________________
Regular Class Enrollment
(See class requirements per level prior to registering)
DB___ Ballet____ Pas____ Jazz____ Mod____ Tap___ HH___ Flam.____ Folk.___ High___ Tumb.___ Acting___ Other_____
D___
D____ D____
D____
D____ D___ D___
D____
D____ D___
D___
D____
D_____
PRIVATE CLASS ENROLLMENT
Cello__ Bass___ Brass___ Fiddle___ Guitar___ Percussion____ Piano___ Violin___ Viola___ Voice___ Woodwinds____
11216 Disco St.
San Antonio, TX 78216
San Antonio School for the Performing Arts
www.saspa.org
[email protected]
210-495-2787 Phone
210-295-0872 Fax