ASTORIA DANCE CENTRE REGISTRATION FORM 
Summer 2009

  Please use one form per student.
Registration fee must accompany this registration form.
Astoria Dance Centre, 25-95 Steinway Street, 2nd Floor, Astoria, NY 11103 718.278.1567

Today’s Date:

New Student Returning Student   

Age:     Birth Date and Year

Student's Last Name, First, Middle
 

Parent / Guardian Name (if under 18)

Address: Street Number and Name (no PO Box)

City   State   Zip

Home Phone   Work or Cell            

Email address  

Years COMPLETED at ADC (do not include Sept. 07-June 08 year) 
  Elsewhere 

Enclosed:
Non- refundable registration fee $15.00

 Total Amount Enclosed

I understand that my tuition payments are due on or before the due date(s) and if not are subject to a late fee of $10.00. I have also read and understand the insurance waiver below for myself and my child(ren). I understand that Astoria Dance Centre, it's employees and staff will be held harmless from any liability or claims resulting from your child's or your participation in this program. I assume all risks in the event of accident or injury to property or person(s) resulting in any activity. I also understand and I will not hold Astoria Dance Centre responsible for loss of personal items. Please be aware that Astoria Dance Centre may take photographs of its dancers for use in promotion of the studio. If this is not your wish, please attach a letter stating so to this registration form. By signing below I agree to all of the above conditions of participation at ADC.


Signature or Parent /Guardian if student is under 18 

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