Classes begin September 5th, 2011

Register Online

PLEASE REGISTER EARLY! This will help to guarantee your preferred class day/time. Please use a separate registration form for each student. You will receive your class confirmation and class time in the mail just prior to your starting date. PLEASE MAIL THIS FORM WITH YOUR REGISTRATION FEE AND FIRST MONTHS TUITION to reserve your spot in a class.

Personal Information
Parent Name	Home Tel	Work/Cell Tel
Address	City, Zip	Email Address

Student Information
First Name Last Name	Birthday	Age	Studio Location(Waupaca or Appleton)
Please List All Classes Student Is Registering For: (Combo, Ballet, Pointe, Tap, Jazz, Hip-Hop, Pom, Lyrical, Modern, Technique)
Previous Years Experience		Previous Studio Taken From
Please check here if you are interested in COMPETING. Try-outs are held to place students in appropriate levels. Additional lessons, lesson fees, and entry fees will be required. In order to excel at competition, all students are required to take ballet.
Please check here if interested in solos, duets, or trios. These classes will be charged a special rate and will ONLY be offered if time and teacher availability allows. Students MUST be registered in an additional class.
Lesson Time: (after what time of day can your lesson be scheduled?)
Day Preferred: First Choice:		Second Choice:
Day/Time it would be impossible to come:

Class Fees (per 4 weeks)

Registration Fee (per family) ..................................................................................... $10.00
Combination Class (30 mins) .................................................................................. $32.00
Ballet, Tap, Jazz, Hip-Hop, Pom, Lyrical, Modern & Technique (50 mins) .........$40.00
Ballet (90 mins) ............................................................................................................ $50.00
Costume Depoit (Due November 1) ........................................................................ $52.50

Registration fee is an annual fee. Students registered in more than one class will receive a 10% discount on each additional class. Additional students residing in the same household will receive a 10% discount. Payment for a full year of classes will be given a 15% discount if payment is made prior to September 1st.

Parental Release

I have read and agree to abide by Pep in Your Step Dance Studio’s policies regarding tuition, late fees, costumes, attendance, and dance attire.
I understand that Pep in Your Step Dance Studio reserves the right to refuse instruction to anyone not abiding by Pep in Your Step Dance Studio’s policies.
I understand that Pep in Your Step Dance Studio reserves the right to cancel a class if enrollment falls below four students per class.
I understand that Pep in Your Step Dance Studio is not responsible for lost items, stolen items, or unclaimed merchandise.
I understand that Pep in Your Step Dance Studio performances are videotaped and may be used for archival and/or promotional purposes.
I understand that participation in a dance program involves risk and possible injury. I understand that Pep in Your Step Dance Studio and its staff will not be held responsible for injuries sustained in class, while performing, or traveling to or from its facilities.
I authorize Pep in Your Step Dance Studio to secure any emergency medical treatment my child might need.
Please list any medical concerns of which we should be made aware:
I allow Pep in Your Step Dance Studio to use my child's name or photographic likeness in all forms and media for advertising, trade or any other lawful purpose.
Please initial: Yes, I Accept: No, I Decline: