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Registration Form

Fill out and print this form, sign waiver, and fax or mail to address at bottom.

Title:
First Name:
Last Name: 
Street Address:
City:  
State:
Postal Code:
Country:
E-Mail Address:
Daytime Phone:
Mobile:
Home Phone:
Dance Studio:
Teacher Name:
How Did You Hear About Us?
Please Specify:
For Children & Teens under 18:
Birth Date:
Age:
School Name:
Grade:
Parent/Guardian Name:
Billing Address (if different):
Billing Name:
Street Address:
City, State:
Postal Code:
Phone:
Email:

Class Choice: Write in class selection with level, day & time.

Youth Program:

Tap City

Youth Ensemble:

Adult Program:

Tuition & Fees: W rite in your tuition amount and total. See the website for tuition for the program you are selecting, or speak to the Registrar. Include Youth Concert Fee (for Youth Program) or TCYE Materials Fee (for TCYE), and include appropriate Registration Fee. (No Registration Fee for Adult Classes or Weekend Tap Intensives)

1. Youth Tuition: $

2. Youth/Concert

Fee: $75

3. TCYE Tuition:

4. TCYE Materials

Fee: $75

5. Adult Class or Intensive:

6a. Youth Program Reg Fee: $40

(non-refundable)

OR

6b. Family

Reg Fee: $50

(non-refundable)

Total = $

Payment Options:

Full Amount is enclosed!

I would like the 3-Installment Payment Plan     (Registrar will send a payment plan agreement and invoice. (For Youth & TCYE only)

I am applying for a scholarship

(For Youth & TCYE only)

Credit Card: (Mail or Fax)

Card Type: Visa, MasterCard, AmericanExpress
Card #:
Exp. Date:
Name on card:

Check or Money Order: ($US)
  • Make check payable to: American Tap Dance Foundation (ATDF) and mail it with this form to the address below.
  •  

    Waiver: I (parents please sign for students under 18) hereby release the ATDF, instuctors, sponsors and all event locations from any and all claims or liability due to personal injury, loss or damage of property which I (or my child) may sustain as a result of participating in any activity connected with the ATDF.

    ______________________________________________
    Signature and Date

    .

    Send to: American Tap Dance Foundation, 154 Christopher Street #2B, New York, NY 10014 Phone (646) 230-9564, Fax (646) 230-7777

    Confirmation Notice: You will receive a confirmation notice by E-Mail.
    Click if you would prefer to receive hard copy via regular mail.
    Please contact us if you don't receive your confirmation within two weeks.