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V o t e d   B e s t   D a n c e   S t u d i o !  

C e l e b r a t i n g   3 7   Y e a r s !   

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ENROLLMENT FORMS

including Summer Enrollment 2017

Print form, complete and submit

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Register

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P.O. Box 656, Quakertown, PA 18951

Quakertown Phone (215) 536-6755         Perkasie Phone (215) 257-4121

cindanz@comcast.net     www.misscindysschoolofdance.com

©2015 Miss Cindy's

We do not have class schedules on the web site and parents should call 215-536-6755 for times. We register each child individually.

MISS CINDY'S SCHOOL OF DANCE, L.L.C.

P.O. BOX 656

QUAKERTOWN, PA 18951

215-536-6755     

                                                 


                            ENROLLMENT FORM FOR 2016-2017

                    

                                 MISS CINDY'S SCHOOL OF DANCE, LLC, 215-536-6755

                                                                   P.O. BOX 656

                                                       QUAKERTOWN, PA 18951


NAME______________________________________________________ AGE_____ BIRTHDATE________________


HOME PHONE ________________CELL PHONE ___________________ ALLERGIES _________________________


EMAIL ADDRESS (FOR MONTHLY NEWSLETTERS):  ___________________________________________________

WOULD YOU LIKE TO RECEIVE THE NEWSLETTER AT CLASS OR THROUGH E-MAIL?  CIRCLE ONE.


ADDRESS ______________________________________________________________________________________


CITY/STATE/ZIP _________________________________________________________________________________


PARENT'S NAME ________________________________________________________________________________


A REGISTRATION FEE OF $25.00 MUST ACCOMPANY THIS FORM BEFORE JULY 31, 2016.  AFTER JULY 31, THE REGISTRATION FEE IS $26.00.  IF INTERESTED IN GYMNASTICS, AN INSURANCE FEE WILL BE REQUIRED.


PLEASE CHECK THE CLASSES YOU ARE INTERESTED IN:


BALLET ____________                  GYM TEAM  __________                                        

                                   

TAP _______________                         TUMBLING & MINI TRAMP ______                                                       


JAZZ / HIP-HOP________                    2-3 YRS. TOT PROGRAM _______


POINTE ____________                 3-5 YRS. PRESCHOOL _________


MODERN ___________                    KINDERGARTEN_______________     


GYMNASTICS ________                    MODELING COURSE ___________

               

TOT GYMNASTICS                         MUSICAL THEATRE  __________          

2- 3 YRS., MOMMY & ME                 

            ___________                          

SOLO, DUO, TRIO (Please circle)  DANCE OR GYMNASTICS ____________                              


VOCAL ___________                                 Partner(s) Name(s) __________________________

                           

*TEACHERS WILL BE ASSIGNED FOR ALL PRIVATE CLASSES. You may not request a teacher.


ANY STUDENT PAYING A FULL YEARS TUITION IN ADVANCE WILL RECEIVE JUNE TUITION AT ½ THE PRICE.  ANY CHILD BRINGING A NEW STUDENT WILL RECEIVE A FREE REGISTRATION FOR 2016-2017.  PLEASE SEND FORMS STAPLED TOGETHER TO RECEIVE FREE REGISTRATION. PLEASE RETURN THIS FORM AS SOON AS POSSIBLE EITHER TO YOUR CLASS OR BY MAIL. THANK YOU.


PHOTO WAiVER: I CONSENT FOR MY CHILD TO BE USED IN PHOTOS OR VIDEOS ON FUTURE PRINT WORK FOR MISS CINDY'S SCHOOL OF DANCE.  YES _____   NO_____  


I understand that all tuition and fees are non-refundable. No refund for missed classes or withdrawal for any reason.


PARENT'S SIGNATURE ________________________________________________________