REGISTRATION FORM
Registration fee and 50% of tuition fees must accompany this registration form.
Please print and submit with your fee by mail at the address below, email dance@astoriadancecentre.com or in person during office hours 3:00-8:00 PM Tuesdays through Fridays; Saturdays 10:00 AM - 5:30 PM; Sundays Noon to 4:00 PM.
42-16 28th Avenue 2nd Floor, Astoria , NY 11103
718.278.1567

Today’s Date:

New Student Returning Student   

Age:     Birth Date and Year

Student's First and Last Name
 

Parent / Guardian Name (if under 18)

Address: Street Number and Name

City   State   Zip

Home Phone   Cell            

Email address  

Medical conditions, disabilities or medications that we should know about

Years COMPLETED at ADC   Elsewhere 

Enclosed:
Non- refundable registration fee $15.00 and 50% of tuition fee enclosed

 Total Amount Enclosed

I have read and understand the waiver below for myself and my child(ren):

I understand that Astoria Dance Centre, its 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 students 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 
_________________________________________

Date: _______________

Classes: _________________________________________________