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E-mail Address:
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Age:
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Phone Number:
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Birthday:
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Complete Address:
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Parent(s), Guardian(s) Names:
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Parent's Cell & Work Phones:
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Emergency Contact Name, Address, Phone:
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List any allergies your child has:
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Please select the class and time you are registering for:
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Please note: Some classes may be full
for the session, please call to check
availability!! 627-9217
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**Please read and check off each statement below then type your name in the box below
indicating that you have read, understand, and agree with the policies listed.**
____Yearly tuition is as follows:4 year old class $1,530, 3 year old class $1,170. I can pay all at once,
or I can break up tuition into 9 equal monthly payments of the amount listed above. I understand that
payment is due on or before the 1st of each month, and if payment is late I will be charged a $10.00 late
fee. There are no discounts for holidays and short months. I will have the option to sign up for
automatic withdrawals.
______A registration fee of $55.00 will be charged for each year I register (there is no registration fee
for summer classes)
______ Additional siblings registering take $5.00 off registration, and 10% off tuition each month.
______Additional fees include a recital fee and a costume fee due in November for the spring dance
recital. I will be required to have ballet and tap shoes for my child for the school year. My child will wear
flexible clothing the whole year so that they may move freely in their classes. (Sweat pants, jogging
suits, shorts, t-shirts etc.)
______**I will not bring my child to class if he/she is sick or contagious in any way!**
______A snack will be provided to my child by Little Gems. Since there is no kitchen or refrigerator, the
snack will always be something prepackaged. If I decide to bring a snack to help out or a treat for a
Birthday, it MUST be prepared in a store or prepackaged. (For health and safety reasons) If my child
has food allergies, I will send a snack for them each day.
______ If I decide to drop out of a class before 6 weeks, one months notice must be given (you must
pay for classes until you have told Annette that you are dropping out). After 6 weeks, no drop outs will
be accepted (with the exception of family relocation). Full yearly tuition is required to drop out after 6
weeks.
______I hereby release Little Gems, its employees and volunteers from any and all liability cost or
expense associated with any injury sustained while participating in Little Gems programs. I give
permission to Little Gems to seek medical treatment in case of an emergency.
______I am required to be ON TIME picking up my child from school. If I am more than 10 minutes late, I
will be charged a $10 fee. If I am stuck in traffic or there is an emergency that will detain me, I must call
and let the teachers know. If a child is not picked up after 10 minutes, the teacher will call me and if I am
not reachable, the teacher will call the emergency contact on this form.
I have read, understand, and agree with Little Gems policies.
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Type your name here for your signature:
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It's a good idea to print this page for future reference of our policies.
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Registration Fee:
You will be prompted to pay the
registration fee through PayPal on the
next page after you click submit.
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