“The Dancing Zone”
Open daily 9:00 a.m. to 5:00 p.m. (early a.m. drop off and late pick up available)
Ages 4.5 to 12 years old
Dancers must bring a lunch. Morning and Afternoon snacks will be provided daily
Student Name: ___________________________________Age:________School:_____________
Parent/Guardian: _______________________________________Cell Phone: _________________
Address: _________________________________________Emergency Phone: ________________
Email: _______________________________________
List any health concerns (allergies):
________________________________________________________________________________
________________________________________________________________________________
Please be advised, program is subject to cancellation if the minimum number of students is not reached.
10 students required
¨ Early morning drop off 8:00 a.m. to 8:55 a.m. $15.00 per day
Please specify day: M
T W Th F
¨ 1 day
$40.00 per day
Please specify day:
¨ Full Week
$200.00
Monday-Friday 9 a.m. to 5 p.m.
¨ Late pick up 5:00 p.m. to 6:00 p.m. $15.00 per day
M T W Th F
Please specify day:
M T W Th F
Total Included
My child will be picked up by ___________________________or ____________________
________________________________________________________________________
We accept CASH, CREDIT CARD and CHECKS
Please make all checks payable to: TOMMY THE CLOWN
Return signed enrollment form and payment to the main office at Tommy The Clown Academy
I hereby enroll my child in TOMMY THE CLOWN INC I hereby expressly forever release and discharge, said programs, and all
instructors, employees, agents, and consultants of TOMMY THE CLOWN INC of liability for any claim, demand, injury, expense,
damage, action or cause of action arising out of or connected with the use of any of the services or facilities of said school, TOMMY
THE CLOWN INC including those arising from acts of active or passive negligence on the part of the instructors, employees, servants,
or agents. I understand that there is no refund for absent days; monthly fees may not be pro-­‐rated, and all fees include early dismissal
days.
Signature: _____________________________________________ Date: __________________________