The Central Pennsylvania Dance Workshop does not accept registration electronically at this time.  To register for classes, print the form below and mail it to us at 101 South Fraser Street, State College, Pennsylvania, 16801; or call 814-237-2666.

 

2007 FALL SEMESTER CLASSES


REGISTRATION FORM

Student Information

Name:__________________________ Age: _______ Grade in School:  _________
New Student ( )/Returning Student ( )
Local Address: _______________________________________________________________________
Permanent Address (PSU Students): ______________________________________________________
Phone:   Local: _____________________________
Other: ____________________________
Other: ____________________________
email: __________________________
Emergency Contact: _________________________________ Phone:___________________________

 

Students under 18 must provide parental information
FATHER's Name:  ________________________
   

Employer Name:  ________________________

 Address: _____________________________ Phone: _____________
MOTHER's Name:  ________________________
Employer Name:  ________________________ Address: _____________________________ Phone: _____________

 

Registration and Payment Information

Please refer to class schedule for tuition amounts.  A $25.00 registration fee is included in the tuition price.  Students taking more than one class pay full price, including registration fee for the first class.  Tuition for each subsequent class (excluding those marked with ¤) may be reduced by $25.00.

A 10% discount is offered on all registrations paid in full by August 24, 2007.  Payment must be received at the studio by this date to qualify.  Postmarks do not apply.

Class Number Class Description Tuition Amount
_____________ __________________________________________ ______________
_____________ __________________________________________ ______________
_____________ __________________________________________ ______________
Total Tuition       ______________
Insurance Fee       _____$10.00_____
TOTAL PAYMENT DUE       ______________

  

Office Use Only
  Amount Date Rec'd Payment Method Received by
Tuition        
Insurance        
Adjustments        
Total Due        
Amount Paid        
    Date Due    
Balance due        

FINANCIAL POLICY:  A minimum deposit of one-half of the total tuition is required at registration.  The remainder is due by the drop date.  Any student who must be billed for tuition will be charged a carrying charge of $5.00 per month, or any part of a month.  Payment plans are available for students who need them, particularly students enrolled in more than one class.

For a student to officially drop a class, a signed withdrawal slip must be received in the office on or before the drop date.  The $25.00 registration fee, yearly insurance fee and a charge for each class which has met will be deducted from the amount paid, and a refund will be sent.

Any student who does not officially withdraw from class by the drop date is financially responsible for the full amount of tuition registered, whether classes are attended or not.

RELEASE FROM LIABILITY:  It is expressly agreed that all exercise, training, dancing, and participation in classes, and the use of facilities of the Central Pennsylvania Dance Workshop by students, is undertaken at the sole risk of students or parents of minor students.  Students and parents of minor students hereby agree to hold the Central Pennsylvania Dance Workshop harmless, releasing forever its employees, owners, operators, agents, servants, advisors, and assignees from any and all claims for injury and/or property damage.

 

I have read and agree to all the above policies and conditions (Parents must sign for students under 18).

Signature                                                                                    Date          /          /         

                               

Registration cannot be accepted without signature.

The Central Pennsylvania Dance Workshop does not discriminate on the basis of race, color, religious creed, handicap, ancestry, national origin, age, sexual orientation or gender.

 

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Central Pennsylvania Dance Workshop

101 South Fraser Street

State College, PA  16801

(814) 237-2666

jillb@penn.com