NAME_____________________________________DOB_______________
ADDRESS_____________________________________________________
TELEPHONE: ______________ HOME _____________ WORK _________CELL
E-mail ______________________________ FUSTA# Primary Beg Nov Int Prem
A Class consists of a minimum of 5-6 dancers.
CLASSES: MON________TUES.________WED_______ THURS.________OTHER_________
First month's Tuition: $
Annual Registration Fee (if not paid during summer) $15 Checks payable to ELEANOR UNGER INC. TOTAL$
I understand I am enrolling for a 10 month school year(Sept-June) which averages 4 classes monthly. Tuition is due on the first week of each month or a $15 late fee is added. All Students must complete annual Registration Forms. A drop out form must be completed one month prior to withdrawing from the school. One month tuition will be charged.
Signed __________________________ (Parent if under 18) Date_________