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Available Classes: |
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Parent/Guardian Name: |
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Primary Phone Number: |
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Secondary Phone Number: |
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The phone numbers you provide should be where you are most easily reached while your child is in our care!
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Street Address: |
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City/State: |
Zip Code:
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E-mail Address: |
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Emergency Contact Name: |
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Emergency Contact Phone: |
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We will contact this individual ONLY in the event we are unable to reach you by phone.
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PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY.
YOU MUST AGREE WITH ALL STATEMENTS IN ORDER TO PROCESS YOUR REGISTRATION FORM.
Understanding that every precaution is taken to ensure the safety of all students enrolled at the PAC, I recognize the potential for physical injury associated with the training of gymnastics and dance. Should my child become injured during his/her training, or while on the property of the Performing Arts Center, I agree not to hold liable, the Performing Arts Center, nor any of its Instructors and/or staff members.
There is NO MEDICAL OR PHYSICAL REASON that my child should be unable to participate and complete his or her instruction in the class or classes selected.
In case of injury, I give my consent to minor first-aid, to be administered by any PAC staff member and my consent for the PAC to seek outside medical treatment if deemed necessary.
Checking the "I Agree" box below and typing your name indicates you are the parent or legal guardian of the student named on this form and that you have read, understand and agree with the preceding statements.
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Name:
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PAYMENT OPTIONS |
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By choosing this option, I agree to allow the PAC to draft my account on the 15th day of each month beginning with the first day of class and ending in the month of May, of the tuition year, approximately May 15th. A voided check and deposit slip are required to be on file in the PAC office for this option |
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By selecting this option, you agree to pay half of the required tuition fee, including registration fees, prior to (or on the start of) the first day of class - usually August 15th. The balance must be paid in full by January 15th of the tuition year. |
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By selecting this option, you agree to pay the entire cost of tuition, including registration fees, prior to (or on the start of) the first day of class - usually around August 15th. |
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Registration Fees for New Students: $25.00 |
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Registration Fees for Returning Students: $15.00 |
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You may come by our office at your convenience or mail required fees & documentation to:
Performing Arts Center - 433 Lee Drive - New Albany, MS 38652 |
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Phone: (662) 534-2458 |
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