Miss Karen's Dance Studio

Registration Form

Miss Karen’s Dance Studio

1700 Sullivan Trail Unit 10-B Easton, PA 18040


  • Please completely fill-out the information on the lines below.
  • Please sign and include the class agreement and liability waiver.
  • Please include payment: cash, check, or credit card
  • Check made payable to: Miss Karen’s Dance Studio

Name _____________________________________________
Address ____________________________________________
City _______________________ State _____________ Zip _______
Tel. #1 _________________________ Tel. #2 ___________________________
Email _____________________________________________

Student’s Name ___________________________________________________
Age _________________________ Birth Date __________________________
Class ___________________________Day/Time ________________________

Please list:
Student allergies: _________________________________________________
Does the student have asthma? _____________________________________
Please describe any current medical conditions: ________________


Dance Class Agreement
Liability Waiver

I ____________________________ parent of _________________________,
understand dance, and related activities, involve risk of injury. I agree I will not hold the studio, its owner, or the staff responsible for any injuries/damages incurred by any of my family members while participating or visiting the studio. __________ (initial)

Authorization of Medical Care: In case of emergency or injury while participating, I authorize medical care for my child, and accept responsibility for medical expenses. __________ (initial)

Picture Release: I hereby give my consent for myself and child to be photographed or videotaped, during any class/rehearsal/performance, for use of the studio and owner for any media use, or learning tool.
__________ (initial)

Class Agreement: Due to the nature of a dance class, some touching and/or placement of proper body alignment might be involved.
I understand and accept this. __________ (initial)

X ___________________________________ Date ______________
signature of parent / participant

I _____________________________________ parent of ___________________________________, have read below and understand Miss Karen’s Dance studio’s rules and regulations, recital commitment, tuition payments, and attendance and drop class policies.
X _____________________________________________ Date _________________
signature of parent / participant
Miss Karen’s Dance Studio’s Rules and Regulations that MUST apply to everyone:
*Safety first! Anyone who is disrespectful to the teacher or other students will be removed from class.
*Please keep unnecessary talking to a minimum during class.
*ALL cell phones should be turned off in any of the dance studios. Cell phones may be used in the front office area or outside the building.
*Parents are permitted to observe class, but please do not allow younger siblings to run around the lobby and disrupt the dance classes.
*Smoking, food, drinks (other than water), candy, or gum is not permitted in the dance studio areas. *Keep your belongings in a dance bag with you in the studio and put your name on everything. The studio is NOT responsible for lost or stolen items.
*PLEASE no street shoes on the studio dance floor! Do not wear dance shoes outside. Change them at the studio. This will keep your shoes clean, in good condition, and protect the dance floor.

2019 Showcase Dates:
*PLEASE mark the following dates on your calendar and plan vacations AFTER recital dates. Rehearsals are MANDATORY!! If your child is not present for the rehearsal, he/she will NOT be permitted to dance in the recital.
Rehearsals: June 6th and 7th
Shows: June 8th (2 shows: 12:00 and 4:30)

Tuition Rates and Payment Information
*There is a non-refundable $20 registration fee or $25 per family, which is due upon registration.
*Classes are based on a yearly tuition from September through June.
*If you choose to pay the entire tuition at registration, you will receive a 10% discount.
*If you pay ½ year tuition, you will receive a 5% discount.
*Otherwise, tuition is broken up into 10 monthly payments, which is due by the 15th of each month.
June tuition is due by recital day, June 8th.
*Payments can be made by cash, check (Miss Karen’s Dance Studio), and credit cards.
*Tuition is the same, regardless of how many weeks are in a month, and there are no deductions for missed classes. If you miss classes in a month, you are still responsible for paying the entire month’s tuition.
Attendance and drop class policies:
*A reasonable amount of missed lessons due to illness or prior engagement may be made up during an appropriate class level/time.
*Please DO NOT take advantage of this policy. Your class teacher will be able to give you the class level/time to make up your lesson.
You will still be required to pay full monthly tuition when missing a lesson.

*You MUST notify Miss Karen, and officially “drop” a class, if your child decides to discontinue classes. If not, you will be responsible for your monthly payments until you do so.

*You will also be responsible for costume costs (if you drop a class after costume deposits are made or full costume cost, if costume is already ordered).

*You will also be responsible to pay for May and June tuition (which helps with recital costs) if you drop a class after April 15th.

I _____________________________________ parent of ___________________________________, have read above and understand Miss Karen’s Dance studio’s rules and regulations, recital commitment, tuition payments, and attendance and drop class policies.
X ______________________________________________ Date _________________
signature of parent / participant