Cathy’s Creative Dance School

ENROLLMENT FORM

 

 

Student(s) name____________________________   Date of birth  ____________

 

                             ____________________________                         ____________

 

                            ____________________________                         ____________

 

Street address ____________________________     Home phone ____________

 

City/State ________________________________     Zip code  ______________

 

Mother’s name  ____________________________    Mobile phone ___________

 

Father’s name ____________________________     Mobile phone  ___________

 

Email address  _____________________________________________________

 

Student lives with:  (circle all that apply)           mother            father          step-parent          grandparent         legal guardian

 

Emergency contact if parents cannot be reached:

 

Name  __________________________________   Phone number ___________

 

Are there any health or physical limitations?  (please explain in detail)  _____________

                                 

_________________________________________________________________

 

Has your child(ren) had any previous dance training?  _______ How many years? _____

 

Person financially responsible for this account: (include address and phone number if different from above) 

 

_________________________________________________________________

 

In order to write checks for tuition, please provide the following information:

 

Drivers license number _____________________ Date of Birth ______________

**If you wish to keep your account on a “CASH only” basis, we do not need this information

 

  *************************************************************************************

(to be filled out by office staff)

 

Date of enrollment  ______________________  Enrollment fee paid _______

 

                                                                                Paid by ________________