Fax: 770-934-8849
SEPTEMBER - MAY  REGISTRATION PRINT OUT FORM

Student:_______________________________________________

Age:________________________D.O.B_____________________

Parent(s):_______________________________________________

Address:_______________________________________________

City:_____________________________ Zip:_________________

Home phone:________________ Cell/Work:__________________

Childcare Center:______________________________

Location:_______________________________________________
                              (Name of street, road or highway)

Please check program preference for your child's school. Acceptance is subject to course availability. Call 770-934-8848 or check with your child's school for specific programs offered there

Pre-Ballet:_____ Tap-Ballet:_____  Pre-Gym:_____ 

 

I have read and understand the information provided in this website. I waive any right to claim against Creative Movement and Dance, Inc. owners, staff, and teachers in the event of accident, injury or loss of personal items. To review policies, click here.

Signature:__________________________________Date:___________

   

Pay by Credit Card:

Card Number:_____________________________________
Exp. Date:______________________________________
Amount to pay:__________________________________

 

Click here for Monthly Billing Authorization Form

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MAIL THIS PAGE WITH $48.00 FIRST MONTH’S TUITION AND $30.00 REGISTRATION FEE ($78.00)

PAYABLE TO:

CREATIVE MOVEMENT AND DANCE
P.O. 390278
Snellville, GA 30039

 

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