Harmony School of Creative Arts | MUSIC & DANCE Registration Information 2008

Student Name:

Age:

Date of Birth:

/ /

School:

Grade:

Parents/Guardian:

Address:

City/State/Zip:

Home Phone :

Cell:

Work:

Email:

Emergency Contact :

Relationship:

Home Phone :

Cell:

Work:

I verify that to the best of my knowledge the student is in good physical health and is able to participate comfortably in the physical exertion required of a dance program.

I give consent for Harmony School of Creative Arts to use photographs or videos of me/my child in their publications and for non-profit purposes & publicity. I understand and accept that my or my child's appearance might lead to people recognizing me/my child.

I understand that full semester payments are preferred, but a monthly payment plan is an option. These payments are due on the 1st of the month, with a $10 late fee to be assessed after the 15th day of the month if payment has not been received. I also understand that Harmony School does not routinely send monthly invoices. I would prefer reminder via:

Email Statement

Mailed Statement

Payment Schedule

I understand that students should notify the school office or their teachers 24 hours in advance if missing a lesson; credits are given only under extenuating circumstances. Private lessons may be made up at the teacher's discretion.

I understand that written notice must be given to the office in the event of withdrawal. (Email is acceptable.)

I would like to set up automatic monthly transactions by credit card. Please contact me by phone to obtain complete credit card information.

I would like information on Financial Aid.

Please list the classes and/or private lessons you will be taking:

I understand that by submitting this electronic form, I have agreed to its contents and am, in effect, providing my signature, and confirm that I am responsible for the student included in this form.