122 Front St, Scituate, MA 02066781-545-3100duvaldancestudio@comcast.net
* Denotes Required Field
**Please be sure to visit our class schedule page before registering.**
* Student Name: * Date of Birth: Current Age: School: Grade Entering: School Hours:
Mother's Name: Mother's Cell Phone: Father's Name: Father's Cell Phone: * Home Phone: * Email: (For class confirmations/events) * Address: * City:
* State: CT MA ME NH RI VT
* Zip:
* Contact Name: (other than parent/guardian) * Phone:
* Are you a new student? Yes No
Number of years at Duval:
How did you hear about us? How many years of dance training does your child have? Name(s) of previous studios: Previous subjects studied:
Are there any medical conditions we should be aware of? Please specify:
Age Level (choose one): Tiny Tots Pre-K1 Pre-K2 Kinder Grade 1&2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 6—8 Grade 7—9 Grade 9—12 Boys ages 7—9 Boys ages 10—12 Zumba
Class: Monday Tuesday
Class: MON AM WED AM WED PM SAT AM
Class: MON PM TUES AM THUR PM SAT AM
Class: WED AM WED PM MON PM TUES PM SAT AM
Class: WED Jazz/HH WED Jazz/HH/Ballet/Tap THUR Jazz/HH THUR Jazz/HH/Ballet/Tap SAT Combo
Class: TUE Jazz/HH TUE Ballet/Tap WED Jazz/HH WED Ballet/Tap SAT Combo
Class: MON Jazz/HH MON Ballet/Tap TUE Jazz/HH TUE Ballet/Tap
Class: TUE Jazz/HH TUE Ballet/Tap
Class: MON Pointe MON Ballet MON Lyrical MON Jazz/HH MON Tap
Class: THUR Jazz/HH
Class: TUE Tap TUE Jazz TUE HH WED Pointe WED Ballet WED Lyrical
Please Note: Your registration will not be complete until a $35.00 non-refundable registration fee per family is received. Payment should be sent to:
Duval Dance StudioP.O. Box 561Scituate, Ma 02066
Terms and Conditions of Registration: I agree to all studio policies and understand tuition is due the first class of each month. Any tuition payments that have been made are non-refundable. Any payments made after the 15th of the month are considered late and charged a $10.00 late fee. I understand costumes are not included in the tuition and I am responsible for payments in October and November. Costume payments are non-refundable and any costumes ordered are my responsibility, even if my child does not complete the year. In the consideration of the dancing lessons afforded to me under this agreement by Duval Dance Studio and in recognition of the physical demands of dancing, I hereby knowingly waive any right or cause of action of any kind whatsoever, arising as a result of such activity from which liability may accrue to Stephanie Nogueira, Duval Dance Studio, or it’s agents. I also give my permission for the public display of any studio pictures that my child may be in. I accept the terms and conditions listed above.
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