premier centre for the arts
Enrollment Application 08-09
Student Name:
Date of Birth:
Address:
Email:
Name of Parent
or Guardian:
Phone #
Referred by:
_______________________________________________________________________________________
DANCE / TWIRLING
Dance Combo
Tap
Jazz
Ballet
Baton Twirling
Alice In Wonderland- Spring
Hip Hop
Dance Ensemble
Private Dance/Baton Lessons
_______________________________________________________________________________________
MUSIC
Mary Grovola
Tom O'Connor
Ed Ryan
Paul Lewis
Stefanie Jaye
Shane Munzert -Associate Teacher
Fred Munzert- Waiting List
Lesson Length
_______________________________________________________________________________________
THEATRE/FILM/BROADCASTING
Theatre Classes
Musical Theatre Ensemble (Elem/Jr/Sr) - audition required
Theatre Workshops
Sound and Lighting Seminar - no registration fee needed.
_______________________________________________________________________________________
Total Amount Due
(Please include $25 Reg Fee)
Credit Card #:
Exp. Date:
Security Code
(3 or 4 digit code)
Additional Comments:
I would like to be
set up on an
automatic payment
plan.  Please contact
me regarding this
option.
By checking the statements below and entering your name in the "signature" box, you
are indicating in writing, your agreement with the terms and conditions of this
enrollment.  Thank you!
I hereby accept all responsibility for any accident, injury, or illness that may occur in
conjunction with this program.  I am releasing and hold harmless Premier Centre for the
Arts and all other parties involved from any and all claims, costs, liabilities and expenses
including all judgments, attorney’s fees and court costs.  I understand that Premier Centre
for the Arts provides no medical insurance for the participants. I am executing this waiver
and release for my child/me to participate in this program.  I have read and agree to all
terms listed in this catalog.  
I understand that 30 days written notice is required should I wish to withdraw from a
class. I understand that I am responsible for all tuition up through the end of my 30 days
written notice
I understand that a $20 late fee will be charged for all tuition paid after the 10th of each
month and that a return check fee is $35.
I understand that from time to time, PCA will photograph events and classes for
promotional purposes.  I give PCA permission to use my/my child’s image and name for
promotional purposes.  
I understand that there are no refunds or credits for tuition.
I understand that there is absolutely no video recording or photography permitted at any
PCA performance.  Failure to comply with this policy will result in ejection from the
event without a refund.
I understand that PCA reserves the right to transfer a student to another class or to
dismiss a student for poor progress and/or attendance or failure to comply with PCA
policies.
I understand that recital participation is a requirement of PCA programs.  Students not
participating in recitals will not be permitted to register for future classes.
There will not be makeup lessons for private lessons missed by the student.  Make-up
lessons will be provided for private lessons missed in the event of inclement weather or
cancellation by the teacher.
Parent / Guardian
"Signature"