MONTHLY MEMBER REGISTRATION FORM

SBDA My Grown-Up & Me 2022-2023

For dancers 1-2 years olds & 3 year olds who missed cut off for tot program!

Thursday at 10:15am-11am

A special class designed especially for the grown up and their toddler. Songs & exercises based on dance and gymnastics fundamentals – specifically designed for this age group, incorporating coordination skills and rhythm exercises. Share moments and create memories with our My Grown-Up and Me class!

ONLY ONE DANCER PER FORM

Class Rates

This program is charged separately than our standard class accounts. For example, if you have an older dancer(s) at SBDA, the charges of this program will apply to a separate account and thus will not qualify for the family pricing rates. . If you have multiple dancers entering the program, each dancer will have their own account. There is one flate rate fee of $50 monthly per dancer. The participating grown-up is not charged.

Each dancer should have their own adult attached to their account, this adult being the one typically being the one attending class with them. This does not have to be the adult responsible paying for the account.

Monthly Member Rate: $50 per month/per dancer (the grown-up is not charged)

*There is a one-time $20 Registration Fee (per dancer) for Monthly Members*

*Monthly fees are to be paid with Cash or Check only at the studio*

Drop - In Rate : $20 per class per dancer (the grown-up not charged)

**DROP-IN families will pay and sign-up the day of class.**

IF YOU PLAN ON ATTENDING AS A DROP IN, YOU DO NOT NEED TO FILL OUT THIS FORM. SIMPLY SHOW UP 10 MINUTES PRIOR TO THE START OF CLASS AND WE WILL GET YOU ALL SIGNED UP.

Parent/Guardian Information

Parent/Guardian's First Name *

Parent/Guardian's Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Parent/Guardian's Phone Number (Best number to reach you at.) *

Parent/Guardian's Email...... This is going to be used to send important updates and information. Please make sure you put an email that is checked often! *

*PLEASE CONFIRM* Parent/Guardian's Email...... This is going to be used to send important updates and information. Please make sure you put an email that is checked often! *

Name of Person Paying Account *

Payer's Relationship to Student *

Dancer Information

Dancer's First Name *

Dancer's Last Name *

Date of Birth MM DD YYYY *

Age of Dancer *

Any Allergies or Medical Conditions we should know about? *

Emergency Contact

**Someone other than the parent listed above**

Preferably another parent/guardian, if not then closest relative/friend.

Emergency Contact's First Name *

Emergency Contact's Last Name *

Emergency Contact's relationship to dancer... *

Emergency Contact's Cell Phone Number *

Typed Parent/Guardian Signature *

Today's Date (MM/DD/YYYY) *

Registration Fee & 1st Month Tuition

We are unable to accept online payments at the moment. By checking this box, you agree to bring the $20 Registration Fee and your $50 first months tuition to the first lesson. *

Yes, I will have the payment with me at the first lesson.

If you have any questions you can email us at southbuffalodance@gmail.com