Center Stage Music Form
Child’s Name:______________________________
Age:____________________ School grade:___________ Allergies:_____________________
Parent’s Name:______________________ Phone #:__________________________
e-mail address:__________________________________
Shirt size ___________________
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Please circle the class you prefer. Classes start August 16th & 17th
Tuesday: 4:30-5:20 (4 years-2nd grade Class A)
5:30 – 6:30 (3rd grade – 12 years Class)
Wednesday: 2:30-3:20 (4yrs- 2nd grade Class B)
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Semester Tuition (August-December 15 weeks) $120
One Time Registration fee: $15
Concert Fee: $10 or $15 for an immediate family with more than one student
Discounts: Prompt Payment $5 off tuition if paid by 1st day of class
2nd Child discount: $10 off tuition
3rd child discount: $20 off tuition
I certify that this enrollee has no condition that prohibits full participation in activities at Center Stage Music. I assume all ordinary risks when using the facilities and hereby release Holly Barrick, Center Stage Music, Craig & Mardyne Andrews, or any of their instructors and employees, for injury or damage suffered in connection with said use of instructors or facilities. In case of an emergency, and I (the undersigned) cannot be reached, I authorize Center Stage Music, and its employees, to contact and secure medical attention for my child. I also give permission to Center Stage Music to use pictures taken during class or performance, of my child.
Signature:_____________________________________________________________________________
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Student Fees
Tuition: _____________
Semester Concert Fee: __________________
One Time Registration (if applicable):__________
Discounts:__________________________
Total:_________________________________
Sizes:_______________________
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