SUMMER REGISTRATION FORM

Select

Student Name(s)

First Name

Last Name

D.O.B.

YYYY

D.O.B

YYYY

Parent Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

AGREEMENT

I have read and agree to the tuition policy, as well as, studio rules and regulations. I understand that I am responsible for full tuition for either summer camp or classes that I am registered in. I hereby waive, release, and indemnify Danceworks of Miami and their agents, employees and independent contractors from any and all liability and damages in connection with my child's participation in this program.

I Agree

CREDIT CARD INFORMATION

The following information is required in order to process your registration form. One full payment will be required for Summer Classes, and Summer Camp payment can be made in full or on a set weekly schedule.

Name (as it appears on the card)

First Name

Last Name

Billing Address

Credit Card Number

Visa/ Mastercard/ Discover Accepted

Expiration Date/ CVC 3 digit code

PAYMENT AGREEMENT

I hereby authorize Danceworks of Miami to charge the amount indicated below:

Summer Camp Deposit $50

Summer Dance Classes (6 Week Session)

Private Lessons

Please list the name of class, day & time for the 6 week summer class(es) you would like to take. This area can also be used to specify which weeks of camp you may be attending.