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2010-11

Parent or 
Guardian 

Address   

 Home # 

City

 Cell # 

Email

 Work # 
May we send you our Monthly Newsletter via email?Yes   No 
May we add your cell number to send text updates?Yes   No 
*you can add multiple email and cell phone numbers at bottom of page
Choose which day of the month you wish to pay tuition?  1st  15th
First Child Information:
Child's Name     Grade 10/11
Date of Birth    Number years involved in studio dance?
1st Class
 2nd Class
3rd Class
4th Class

Second Child Information: (*25%Off Monthly Tuition)
Child's Name     Grade 10/11
Date of Birth     Number years involved in studio dance? 
1st Class
 2nd Class
3rd Class
4th Class

Third Child Information: (*50%Off Monthly Tuition)
Child's Name     Grade 10/11
Date of Birth     Number years involved in studio dance? 
1st Class
 2nd Class
3rd Class
4th Class
Fourth Child Information: (*75%Off Monthly Tuition)
Child's Name     Grade 10/11
Date of Birth     Number years involved in studio dance? 
1st Class
 2nd Class
3rd Class
4th Class
Family Waiver:
 I realize the risks inherent in any movement program, and I waive, release and hold harmless In Motion Dance Studio, the staff, the directors, guest artists, and other instructors from any and all claims, costs, responsibilities, expenses, and/or judgments, out of my own participation or the participation of myself/child(ren) in any of the classes offered. To help ensure my/my child’s safety, we will wear the appropriate attire and footwear for class. I authorize the release of my/my child’s photos and video footage to In Motion Dance Studio for exclusive use in www.in-motiondance.com web, advertising, and promotion.  I understand and will abide by the Studio Policies and Rules. I understand that my payments are due per the dates selected upon registration and late fees for every seven (7) days past due will be charged.  By checking the adjacent box, I am agreeing to all the aforementioned requisites as a pre-condition of completing class registration.
How you will pay your first month tuition & registration fee*:
 Mail Check to Studio          Online  (after clicking "submit" below there will be a link to follow)
 *Tuition and the registration/insurance fee is required in order to reserve your child's place in class
If there is any additional information or questions, please type it in below.  If you were referred by an In Motion student, please tell us here! Also additional email/cell numbers should be listed here...
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