Dancer's Name

First Name

Last Name

Date of Birth

YYYY

Parent/Guardian's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home/Cell Phone

(###)

###

####

Home/Cell Phone #2

(###)

###

####

Emergency Contact

Emergency Contact Phone

(###)

###

####

Does your dancer have any medical conditions we should be aware of?

Are you a returning dancer?

How did you hear about Melrose Dance Academy?

Is there anything else we need to know?

Tuition & Late Fees

- Monthly Tuition will be billed on the 1st of each month or upon registration if past the 1st. - There will be 9 months of tuition billed to each account, September through May. Tuition is never prorated. All holidays and vacation weeks are built into the total cost of tuition. - There is a $35 non-refundable registration fee. If it is not paid after two weeks of registering, we will release your dancer's spot in the class. - There is a $25 service fee for a returned payment. - There is a $25 late fee for each month a tuition payment is past due.

I've read the above and agree

Withdrawal & Missed Classes

-Class withdrawal requires a 30-day written notification or you are responsible for tuition for that month. -Full payment is due regardless of illness, holidays, or inclement weather. -Students can make up missed classes by attending a similar class up to two (2) weeks after the absence.

I've read the above and agree

Photo Release (SELECT ONE OPTION)

I hereby grant and authorize Melrose Dance Academy the right to take, edit, alter, copy and make use of any and all pictures or videos taken of my dancer to be used in and/or for promotional materials including, but not limited to, newsletters, flyers, posters, brochures, letters, annual reports, and social networking sites for business use only. This is done without payment or any other consideration. This authorization shall continue indefinitely unless parent/guardian revoke in writing. I understand and agree that these materials shall become the property of Melrose Dance Academy and/or other facility that I represent, and will not be returned.

I DO NOT consent to the above Photo Release agreement and I do not want my dancer’s picture used for promotional materials, including, but not limited to, newsletters, flyers, posters, brochures, letters, annual reports, and social networking sites for business use only. Any photographs or digital images in which the subjects cannot be identified by the naked eye (i.e. wide shots of the stage containing the entire cast of the Recital) will be published at the discretion of Melrose Dance Academy.

Release of Liability

Please be advised that all dancers dance at their own risk at Melrose Dance Academy. I understand and agree to hold harmless, all instructors, assistants, aides, managers, and all affiliates to Melrose Dance Academy for any and all injuries that may result from my child/me participating MDA’s dance program. Additionally, I agree that Melrose Dance Academy is not responsible for any lost or stolen items that may occur while participating.:

I've read the above and agree

Medical Release

In the event you are unable to reach me, in the case of accident or injury, I give my permission for treatment as deemed necessary by Melrose Dance Academy staff or emergency personnel. I also release Melrose Dance Academy and staff of liability in case of injury or accident.

I've read the above and agree

COVID-19

I agree to follow and have my dancer(s) follow all Melrose Dance Academy protocols and understand that failure in doing so will result in not being able to return to class. I agree to only send my dancer(s) if they have not in the past 7 days: experienced any symptoms such as coughing, fever, shortness of breath, sore throat, etc. or been exposed to anyone who may have been in contact with the virus

I've read the above and agree

I AGREE TO ALL OF THE ABOVE

Date

YYYY

Thank you for submitting your registration form! You will receive confirmation from us once your registration is complete. If you do not see a confirmation email within 48 hours, please check your spam folder.

For tuition details & more information about the studio:

Download the Studio Handbook

2024-2025 Dance Season Registration

Contact Us!

(781) 665-6993 • 22 Corey St. Suite 203. Melrose, ma 02176