1013 Market Street • Gowrie, Iowa 50543 • (515) 352-5476

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Enrollment

Classes start Tuesday, September 8th, Wednesday, September 9th and Monday, September 14th.

To view the class schedule, click here.

Student(s)*
Please click the + sign to add additional students that you're enrolling per family.
First Name Last Name Age Birthday Gender Phone
Address*
Street Address City State ZIP Code
Home Phone
Email*
Father's Name
First Last
Father's Cell Phone
Mother's Name
First Last
Mother's Phone
School
Grade in School
Has student had previous training?*
- Yes
- No
Studio Name
Years in Tumbling
Years in Dance
Does your student have any physical disabilities?*
- Yes
- No
Does your student have any medical concerns?*
- Yes
- No
If yes, please explain:
How did you find us?
- Facebook
- Instagram
- Online
- Newspaper
- Friend
- Current Student
Student/Class #1
*NOTE: Classes are subject to change.
Student/Class #2
*NOTE: Classes are subject to change.
Student/Class #3
*NOTE: Classes are subject to change.
Student/Class #4
*NOTE: Classes are subject to change.
Enrollment Fee
Price:
Total
$0.00
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PLEASE READ
Lesson fees are paid monthly. I understand that lessons are due in advance the 1st lesson of the month and that lesson fees paid after that will be assessed a late fee of $15.00. All costumes fees for dancers and tumblers are due October 15th. Costumes for ages 10 & under or child sizes are $50/ costume. Costumes for ages 11 & up or adult sizes are $60/ costume. Some classes may have 3 costumes. This is an estimate of what I think the costumes will cost. There could be an additional charge per costume, if the price exceeds what I have projected, in which case the remainder of the cost will be billed in January. All of my students have enjoyed performing in our annual recital which is usually held in May. Information will be given to you later. Students in the recital pay $40.00 per family by March 1st. This entitles each student’s family and friends to see the recital FREE.

Any activity involving motion, rotation, or height creates the possibility of injury slight to serious. I attest and verify that I have full knowledge of the risks involved in these lessons, and give permission to seek medical help if needed. I have also received and read the information booklet about the school. In consideration, of the acceptance of this application for registration, I intending to be legally bound for myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damages I may have against Vicky’s Dance Academy or its representatives and or/assignees, for all damages which may be sustained and suffered by my child named on the form, in connection with association with or entry in this school and which may arise out of traveling to , participating in, or returning from the school. This school does not provide medical insurance. There are NO REFUNDS ON LESSONS, COSTUMES, FUNDRAISING, AND RECITAL FEES. I UNDERSTAND THAT ALL VIDEOS AND PICTURES CAN AND WILL BE USED FOR THE PROMOTION OF THE STUDIO.

I HAVE READ THE ABOVE AND GIVE MY PERMISSION FOR MY CHILD TO BE A PARTICIPANT AT VICKY’S DANCE ACADEMY.
Parent/Guardian Signature*

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Category: Enrollment

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