Premier Centre for the Arts
Registration

Please complete the following to register for classes. * Denotes required field

 
Registrant Information
Name*
Date of Birth
Address*
Email Address*
Name of Parent / Gaurdian
Phone*
Referred By
 
Dance
Dance Combo
Jazz
Ballet
Modern
Twirling
Dance Production
Hip Hop
Dance Ensemble
Tap
Dance Costume Fee
Preschool
Samantha Kaiser Private Dance
Jamie Parker Private Dance
 
 
Music
Pat Daniels
Missy Grynkiewicz
Paul Lewis  
Tom O'Connor
Ed Ryan
 
Rose Minio - Associate Teacher
Cody Munzert - Associate Teacher
 
 
Theatre
Theatre Classes
Musical Theatre Ensemble
Children's Production
Theatre Costume Fee
 
DVD Orders and Snack Cards
DVD
Snack Card
 
Registration Summary
Coupon Code
Total Class Fee $0.00
Registration Fee $0.00
Coupon Discount -$0.00
Total Amount Due $0.00
 
Payment Options

A credit card is required to complete the process. Please verify your information is correct before submitting.

Card Number*
Expiration Date*
Card Identification Data
(CID #)*
 
Additional Comments

I would like to be set up on an automatic payment plan. I grant permission to Premier Centre for the Arts (PCA) to charge monthly tuition on the first calender day of each month to the credit card provided. In the event a student is withdrawing from a program at PCA - 30 days written notice must be given; at this time PCA will charge the credit card provided with the balance due and then deactivate the automatic payment.
I am making a payment on my monthly tuition.
 
Agreement

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. 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 understand that 30 days written notice is required should I wish to withdraw from a class and that I am responsible for all tuition up through the end of my 30 days written notice. There are no refunds or credits for tuition.Make-up lessons will be granted when at least 24 hours notice is given for missed lessons or in the case of closure due to inclement weather.
* 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 is absolutely no video recording or photography permitted at any PCA performance.
 

Parent / Guardian "Signature"
   
 
Theatre
Music
Dance
SummerArts
Fitness/Adults
Dover Location

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