BACKSTAGE DANCE STUDIO

7185 Columbia Gateway Drive, Columbia, MD 21046 410-312-0900 (phone) ~ 410-872-9972 (fax)
www.TheBackstageDanceStudio.com (web) ~ info@TheBackstageDanceStudio.com (email)

2011-2012 REGISTRATION FORM

Classes Begin Tuesday September 6, 2011

REGISTER BY JULY 9, 2011 and RECEIVE 50% OFF REGISTRATION FEE!

Student Name: _________________________________________________________

Phone: ______________________________

D.O.B._____________________ Age: ____________

Address: _______________________________________________________ City: _______________________

Zip: ___________

Adults Name: ____________________________________________ Relationship to Student: ________________________________

Work #: _____________________________________________ Cell #: __________________________________________________
Adults Name: ____________________________________________ Relationship to Student: ________________________________
Work #: _____________________________________________ Cell #: __________________________________________________
**Email Address (required): __________________________________________________________________ (one email per family)
(ALL communication will be made through this email address)

DAY(S)

TIME(S)

BALLET

: _____________________________________________________________________

POINTE

: _____________________________________________________________________

JAZZ

: _____________________________________________________________________

MODERN

: _____________________________________________________________________

LYRICAL

: _____________________________________________________________________

TAP

: _____________________________________________________________________

HIP-HOP

: _____________________________________________________________________

ROCKIN TOTS

: _____________________________________________________________________

All Lyrical students must be enrolled in at least one ballet class. All Pointe students must be enrolled in at least two ballet classes.
Tuition is broken into 5 equal payments with the first tuition payment due at time of registration along with a $25.00 registration fee per
student ($10.00 for each additional family member). Registration fees are non-refundable and non-transferable. Registrations are
taken throughout the summer, and classes will be filled on a first come, first served basis. Tuition is also non-refundable and nontransferable once a tuition period has started. Please mail this form with your first payment and registration fee, and a place will be
reserved for you in the selected classes. You may also fax your registration form to the studio with your credit card information.
Your signature on the registration forms constitutes an agreement with Backstage Dance Studio, and demonstrates that you have read
and understand our studio and tuition policies.
It is the responsibility of the parents to read through and agree to all studio policies which can be found on our website.
I have read and understand the Studio & Tuition Policies of Backstage Dance Studio.
PARENT/LEGAL GUARDIAN SIGNATURE

___________________________________________________

DATE

__________________
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2011-2012 TUITION 5 EQUAL PAYMENTS

$65.75
$96.50
$127.50

30 min class
45 min class
1 hour class

ROCKIN TOTS SESSIONS:

Fall Session:
Winter Session:
Spring Session:

9/10/11 12/3/11 (12 week session)

1/7/12 2/25/12 (8 week session)
3/3/12 5/19/12 (12 week session)

Tuition: $153.00
Tuition: $103.00
Tuition: $153.00

There will be a $10 registration fee for your RockinTots session of the year.
Tuition discounts do not apply to Rockin Tots
2011-2012 DISCOUNT RATES:
3 classes
4-5 classes
6-7 classes
8 or more classes

3% off entire tuition

5% off entire tuition
8% off entire tuition
11% off entire tuition

Pay tuition in full for the entire year at time of registration, and receive an additional 5% off!
First Tuition Payment

$__________________________________

Discount % for Multiple Classes

$__________________________________

Discount 5% for 1 Year Payment in Full (Cash or Check ONLY)

$__________________________________

Registration Fee ($25/$10 each additional sibling)

$__________________________________

Total Amount Due

$__________________________________

Refer a non-sibling friend and receive a $15.00 credit, good towards tuition.
Referred student must remain in class for two months in order for referring student to receive the credit.
Please mail or fax all pages of this registration form with your payment to:
Backstage Dance Studio
7185 Columbia Gateway Drive, Suite J
Columbia, MD 21046
FAX # 410-872-9972
Make checks payable to BACKSTAGE DANCE STUDIO.

CREDIT CARD PAYMENT:

VISA______

MasterCard______

Discover______

Name of Cardholder:

_____________________________________________________________

Card #:

_____________________________________________________________ Exp. Date: _______________

CVC#:

______________________ (3-digit number on back of card near signature strip)

Cardholder Signature:

_____________________________________________________________
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