Please select:
Majorette     Dance     Tumbling

STUDENT INFORMATION

Student�s Name:     Birth Date:     Age:
Gender: Male     Female   
Address:     City:     Zip Code:    

Mother's Name:     Cell Phone:    
Work Phone:
Emergency Contact: Yes   No          Authorized Pickup: Yes     No

Father's Name:     Cell Phone:    
Work Phone:
Emergency Contact: Yes   No          Authorized Pickup: Yes     No

Emergency and Pick Up Authorization: Persons authorized to pick up and to be contacted in an emergency if I/we cannot be reached.

1. Name:     Relationship to child:     Phone:
2. Name:     Relationship to child:     Phone:
3. Name:     Relationship to child:     Phone:

Please list any known allergies:

How did you hear about our studio?

Please list prior dance experience (i.e., number of years, technique studied, teachers, etc.):

Payment: Payment is due by the 5th of every month. A $10 late fee will be assessed to all payments received after the 5th and students will not be allowed to attend class until account is current.

Payment Options:
Cash payment in person on the first of each month.
PayPal, eCheck, Debit or credit card payment on the first of each month, via automatic draft
Payment of tuition in full at registration to cover classes through May 2017. (Check, cash, debit, credit, or money order only).

Registration Fees:
New Student: $165
Returning Student: $30

Class Fees:
2-5 years old will take one class per week consisting of Ballet, Jazz, Tap and Tumbling
Beginners will take two classes per week. Class 1 consists of Ballet. Class 2 consists of Lyrical, Jazz, Hip Hop and Tap.
Intermediates and Advanced will take two classes per week. Class 1 consists of Ballet. Class 2 consists of Lyrical, Jazz, Hip Hop and Tap.
$60 for first class, $25 for each class after
$10 discount off total for 2nd child
$5 discount off total for 3rd child +

Child�s Shirt Size      Child�s Shorts Size      Child�s Shoe Size  

I understand that all fees paid are nonrefundable and nontransferable. The parent or guardian is responsible for notifying, in writing, Imani Dance Academy of any change to the credit card or checking account. The returned check/declined card fee is $35. Should this provision have to be enforced by legal means, the undersigned person(s) is responsible for payment, as liquidated damages, the costs of collection, plus interest at the legal rate and reasonable attorney�s fees as determined by the Court or 15% of the amount collected failing such determination.

EMERGENCY INFORMATION

Physician:     Hospital Preference:
Insurance Company Policy No.:
Allergies (food, medicine, etc):
Additional Information/Comments (i.e. blood transfusions, etc) :
 

 

 

 
 
 

9830 Lake Forest Blvd Ste 122
New Orleans, LA 70127
504-261-2145