To Register: Complete and sign this form; send payment of  first months tuition; add $10 Registration Fee; if using credit card please complete form.  Make checks payable to:  Toni Schwartz Studio of Dance, 7423 New Falls Road, Levittown, PA  19055.

Registration Form  2011-2012                  Circle One:     SUMMER        FALL
                                                                                         Summer Session 1___    Summer Session 2___
Student(s) Name:_____________________________________________________________
Home Phone:___________________________Cell Phone:____________________________
Work Phone:____________________________Parent's E-Mail:________________________
Birthdate:_______________________________Age:________________________________
Address:____________________________________________________________________
_______________________________________________Zip Code:____________________
Parent's Names:______________________________________________________________
Do you check your e-mail regularly?  Yes---No
May we contact you via e-mail?   Yes---No
Party Responsible for Tuition:  Self   or    Their Name:________________________________
Their Address:  ______________________________________________________________
Their Telephone Number:______________________________________________________
Emergency Contact:________________________________Phone No.__________________
Former Studio:____________________________________   Years of Training:___________
How did you hear about Toni's:      Internet----Ad-----Drive by----Referral:  Who?____________
*IMPORTANT:  Information is completely confidential but crucial:  Please list medical, social or
learning disabilities and/or medications:__________________________________________

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Student(s) cannot be "dropped offf" any earlier than 15 minutes prior to 1st class. 
Student(s) must be "picked up" IMMEDIATELY upon class ending.
Parent/Guardian must be present with their student during Pre-School Classes.
Students under age 7 should have an older sibling or adult waiting during their class.
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CLASS SELECTION
Please enter class name and time:
MONDAY:_________________________________________________________________
TUESDAY:  _______________________________________________________________
WEDNESDAY:_____________________________________________________________
THURSDAY:______________________________________________________________
FRIDAY:_________________________________________________________________
SATURDAY:______________________________________________________________
                        Number of Hours danced per week:__________________

TUITION IS PAYABLE monthly at the 1st CLASS OF THE MONTH.
A $10 LATE CHARGE is automatically added to tuition on the 11th of the month.
RECITAL TICKETS CANNOT BE PURCHASED if tuition account is not current.
INSUFFICIENT FUNDS Charge is $35, resulting in cash payment.
BILLINGS  are automatically mailed every 30 days for all unpaid balances.
BEHAVIOR by a student or parent deemed "Inappropriate" is at Director's discretion and may result in dismissal.
DROP-OFF/PICK-UP POLICY must be followed or may result in dismissal.
RECITAL COSTUMES must be paid in full by:  11/12/11. Partial payments accepted in advance.
PERMISSION is granted to TSSD to use student images for promotional use on website, facebook, 
advertising, etc.
NO REFUNDS.
MY SIGNATURE indicates I have read and fully understand and will comply with the Studio Policy, as set forth and signer assumes all risks and hazards incidental to participation at TSSD. I have been informed of tuition deadlines, late fees, costumes payments, attire, etc.

Signature:____________________________________________________Date:_____________