Cathy Kurth Dance Academy

137 Bruce Circle    PO Box 12524    Moss Bluff, LA 70612 (337)855-3525

“Lessons That Last A Lifetime”

Registration Form

Parent’s Name:  _________________________________________Phone:  ___________

Address:  _______________________________________________________________

City:  __________________________________  State:  _________   Zip:  ___________ 

Email address:  _________________________________________________________

Cell Phone:  (for emergency use only) _____________________________________

Child’s Name:         Class 1:                   Class 2:                 Class 3:                   Class 4:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                         

Registration $25 (+ $10 for each additional child) Fee Pd ___________Monthly Tuition: ___________

Costume Payment Plan ______  (You must choose A or B)

A – Pay before September 10th and receive 10% discount         B – Pay in 4 equal installments Sept - Dec

**Please read all information carefully and completely before signing registration form**

_____  Yes, I have received, read and understand all information in the “What’s It Gonna Cost Me Sheet”, the “What Do I Need?” sheet,the “Welcome” sheet and the “Message from Ms Cathy” sheet.

I,  __________________________ ( print parent’s name), have read and fully understand all that is expected of me and my child while attending classes at CKDA. 

______________________________(Parent’s Signature)______________  (Date)                                    **If paying the year in full by September 10th, take 10% off.  Please exercise caution, as tuition cannot be refunded.  Costume money can be refunded if child drops and we are notified before December 31st.  However, once costumes are ordered, you are responsible for them.