Registration/Policy Form

Print then mail completed form with check or bring in to studio with you

Student Information:             Date Registered: _____________

Name: __________________________________________

Address::_______________________________________

City: ______________    State: _____    Zip Code: ________

Day Phone::____________ Evening Phone:___________

Age: __    Date of Birth: ___/__/___    Height::___    Weight::___

Mother::_____________________    Day Phone::____________ 

                                                           Evening Phone::____________ 

Father::_____________________    Day Phone::____________ 

                                                           Evening Phone::___________ 

Emergency Contact information:

Name of contact:______________________________

 Relationship to student:_________ Day Phone::__________ 

                                                           Evening Phone::__________ Any Health Problems, Medications, etc:___________________

Classes - Please list:     

      Class Level        Day/time        Class Length

1.   __________        _______        ____________

2.   __________        _______        ____________

3.   _________        _______        ____________

4.   __________        _______        ____________

5.   __________        _______        ____________

          Total Hours per week:        ____________

Do you want to be billed each month?  Yes    No

Tuition Schedule/Policy

Tuition is based on total hours per week

1. Tuition paid IN FULL at the beginning of the semester receies a 10% discount.  Tuition may also be paid monthly.

2. Tuition must be paid by the 10th of every month, or a $10 late fee will be charged for each week that payment is late

3. Registration for classes is based on 10 months, At the time of registration, tuition will be due for a minimum of 3 months.  After 3 months In Motion must receive written notice 30 DAYS PRIOR to any classes dropped.

4. YEARLY registration fee is $15 single, $20 for two, and $25 for family*

*CURRENT students must register before a new semester starts, or a $10 late fee will be charged

* No refunds - missed classes due to holidays, school closures and illness may be made up with the director's permission.

Release & Agreement

I have read and understand and accept the Tuition Schedule/Policy.  I do hereby release IN MOTION, it's staff, instructors, their landlords or lessors from any and all liability for injury to my person or for loss or damage to property.  I, the undersigned, do hereby acknowledge that IN MOTION will not accept responsibility for immediate medical needs of its students.  In consideration thereof, I hereby agree that an emergency telephone number shall be on file in the office.  I have read, understand and accept the foregoing release and conditions of enrollment in IN MOTION classes.

_________________________________                                    ____________

Signature (parent and/or guardian if student under 18)                Date