Registration Form

Students Name:_________________________________________

Date of Birth:__________ Age:______

Academic School:_______________________________________

How many years of training have you had?_______

With whom have you studied?_______________________________

Address:_______________________________________________

City:____________________ Zip Code:______________________

Home Phone:__________ Work Phone:_______________________

Cell Phone:____________ Email:____________________________

Mother's name:__________________________________________

Occupation:_____________________________________________

Place of employment:______________________________________

Father's name:___________________________________________

Occupation:_____________________________________________

Place of employment:______________________________________

Driver's License # :________________________State:___________

How did you hear about our school?___________________________

Please list any pertinent information we should know about:

Allergies, Physical Disabilities, Medical conditions

________________________________________________________

In case of emergency please contact:

Name:___________________________________________________

Address:__________________________________________________

Phone:____________________ Relationship:___________________

POLICIES AND GUIDELINES

FOR PARENTS AND STUDENTS

Dear parents and students:

This brief agreement is to ensure clear communication and make your experience at our dance school a pleasant one.

We ask that you read this carefully and sign at the bottom.

Registration

A registration form along with a non-refundable fee of $50.00 for one family member, $80.00 for two family members and $100.00 for three or more.

This fee must be received in order to reserve your child’s place in class.

As you register in our school you are reserving a place that could be filled by another student. This means that whether or not the student attends all classes during the month, tuition still must be paid (just like a private school). If the student chooses to drop out of classes he or she must inform the school in the beginning of the month. If the school is not informed you will be charged for that month. If he or she wishes to return a new registration fee will apply.

Tuition Policy

The tuition is due on the first of the month and will be considered past due after the 15^th of the month. There will be a $10.00 late fee for every 15 days the tuition is late. If tuition is more than 30 days late, the student will not be allowed to take classes until payment is made. If the student is absent the first week of the month please mail your tuition, in order not to receive any late fees. As our calendar year and tuition rates have been pro-rated. They are based on lessons received for an entire school year and not on the amount of classes per month. (This policy is applied at studios everywhere.) If you have any questions or payment inquiries, please let us know. There will a $30.00 charge for NSF checks and any other returned checks. After two returned checks only cash will be accepted.

Make up Classes

You can “make up” for a lost class only if the student was sick. Make-up’s do not include when you choose to go on a trip or attend another event etc. This does not make you eligible for a “make up” class.

Arriving late

Arriving late for classes is not acceptable, if a student arrives late repeatedly the parent will be called to see how this problem could be resolved. If the student continues arriving late they will be asked to sit down for the class.

Dress Code

All students must come to class in a clean neat uniform. Hair must be neatly pulled back in a bun, if the student has short hair the hair must be pulled back with clips away from face. All ballet students must have a class leotard with pink footed tights and pink ballet slippers. All Jazz students must where black jazz pants with black jazz shoes and black leotard, Contemporary students black footless tights and a solid colored leotard, Tap students black tights or pants and a solid colored leotard and Flamenco students black leotard, flamenco skirt and shoes. Boys must have a white clean T-shirt tied around the waist with a belt or elastic, black ballet shoes and black tights.

Absolutely no leg warmers, sweaters or sweatshirts allowed. Skirts will only be allowed on special days, at the discretion of the student’s teacher.

*Absolutely no gum chewing, food or drinks inside studio at anytime.

*For added safety no long chains, long earring or bangles etc. will be allowed during class.

*Please do not bring any kind of jewelry to the studio we cannot be responsible if lost or stolen.

*Please be prompt to pick up your children. After class we ask that all students remain in the building for pick up. We will not be responsible for children waiting outside the building.

*Please arrive at least ten minutes before class so that the student may be prepared to start on time.

*Bringing other children to the studio is not recommended. If you must bring other children, please be responsible for their behavior. Remember that this is a dance studio and not a playground.

Thank you,

Marielena Mencia and Yanis Pikieris

POLICIES AND GUIDELINES

I have read the above and agree to comply

Student’s name: _______________________________________________

Parents Signature: _________________________________

Date:__________

Release and Waiver of Liability and Indemnity 2011 - 2012

__________________________, Parent of ______________________

(Student), agrees that the student’s use of Mencia-Pikieris School of Dance facilities, equipment, services

or premises may involve risk of injury to persons, including those injuries described below. Student and Parent

assume full responsibility. Parent and Student hereby release Mencia-Pikieris School of Dance, its directors,

employees and agents harmless from all liability for any loss or damage, for injury to Student, whether caused by

the active or passive negligence of Mencia-Pikieris School of Dance. Student agrees to indemnify Mencia-Pikieris

School of Dance for any loss, liability, damage it may incur due to the presence of the Student in, upon or about the

Mencia-Pikieris School of Dance premises, facilities, services or equipment. Parent represents that (a.) the Student

is in good physical condition and has no disability, illness, or other condition that could prevent Student from exercising

without injury or impairment of health, and (b.) that Student has consulted a physician concerning an exercise program

that will not risk injury to student or impairment of Student’s health. The risk of injury may include injuries arising in

participation by Student in supervised or unsupervised activities at the school; injuries and medical disorders arising from

exercising at the School such as sprains, broken bones, torn ligaments, torn muscles, heart attacks and strokes and

accidental injuries occurring anywhere at the School. Parent agrees that the foregoing release, waiver and indemnity

agreement is intended to be as broad as is permitted by the laws of the State of Florida and that if any portion is held

invalid, it is agreed that the balance shall continue in full force and effect.

Parent Signature:____________________________________Date:__________________