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Broadway Bound Dance Academy
Fall 2019 Registration Form

New Student: If you need help with proper class placement,
please call us at (610)891-9959.

Registration is not final until your payment is received
by cash or check.

Please fill out one form per student (fields with (*) are required)

Student's Name (*):
Birth Date: / /
Parent's Name:
Home #:
Work #:
Cell #:
E-mail (*):
Are there any health concerns we should be aware of?
Please list all of the classes you will be taking:

By signing this contract I agree to submit payment in a timely fashion for the duratoin of services rendered. I realize that no refunds will be given after the second class of the summer, but that if the student should decide after the first class not to continue, I will be given a full refund, minus a $5 processing fee. It is the student's responsibility to attend all classes, and there will be no refunds, discounts, or credits given for classes missed.

By signing this contract I understand that dance is a physical sport, and that there are certain risks involved including, but not limited to, sprained or broken limbs and pulled muscles. I agree that Broadway Bound Dance Academy L.L.C. and all those associated with it are not to be held responsible in the event of injury. I also understand that bringing money or others of value to the studio is at my own risk, and I will not hold Broadway Bound Dance Academy L.L.C. or anyone associated with it responsible in the event of my possessions are lost or stolen.

I have read and understand the agreement (*):


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