Dancer's Name
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First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Parent/Guardian's Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
*
Home/Cell Phone
*
(###)
###
####
Home/Cell Phone #2
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(###)
###
####
Emergency Contact
*
Emergency Contact Phone
*
(###)
###
####
Does your dancer have any medical conditions we should be aware of?
*
Are you a returning dancer?
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Yes
No
How did you hear about Melrose Dance Academy?
Please check the classes you would like to enroll in
*
Is there anything else we need to know?
Tuition & Late Fees
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- Tuition will be billed at the end of June.
- There is a $35 non-refundable registration fee.
- There is a $25 service fee for a returned payment.
- There is a $25 late fee for past due tuition
-If the tuition is not paid by the due date, your dancer will be withdrawn from the class or camp that was selected.
Withdrawal
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-Class withdrawal requires a 30-day written notification or you are responsible for full tuition.
Photo Release (Please select ONE)
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-Please be advised that all dancers dance at their own risk at Melrose Dance Academy. I understand and agree to hold harmless, all instructors, assistants, aides, managers, and all affiliates to Melrose Dance Academy for any and all injuries that may result from my child/me participating MDA’s dance program. Additionally, I agree that Melrose Dance Academy is not responsible for any lost or stolen items that may occur while participating.
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Medical Release
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In the event you are unable to reach me, in the case of accident or injury, I give my permission for treatment as deemed necessary by Melrose Dance Academy staff or emergency personnel. I also release Melrose Dance Academy and staff of liability in case of injury or accident.
COVID-19
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I agree to follow and have my dancer(s) follow all Melrose Dance Academy protocols and understand that failure in doing so will result in not being able to return to class. I agree to only send my dancer(s) if they have not in the past 10 days: experienced any symptoms such as coughing, fever, shortness of breath, sore throat, etc. or been exposed to anyone who may have been in contact with the virus
I AGREE TO ALL OF THE ABOVE
*
Date
*
MM
DD
YYYY
Welcome to Melrose Dance Academy! Once we have received your registration form, you will receive a confirmation email within 48 hours. If you do not see a confirmation email, please check your spam folder.
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