Sportsplex @ Fairfield
Ballroom and Latin Dance Fairfield, Connecticut
Season: September 2018 - June 2019, Classes start first week of September


SESSION September 3, 2018 – June 29, 2019
Student’s FIRST name: _______________________ LAST name: ________________________________
Parent/ Guardian full name: _____________________________________________________________
Address: ___________________________________City: __________________State: CT Zip: ________
Parent Cell #: _______________________________ Secondary Phone #: _________________________
EMAIL: ____________________________________ Relationship to student: ______________________
Class __________________________________Day ___________ Time_________________________
Class __________________________________Day ___________ Time_________________________
Class __________________________________Day ___________ Time_________________________

Tuition Total ___________________________
When you register for a class at Ballroom Dancesport Center you are COMMITTED for the FULL 10 months SESSION, star ting on September 3, 2018. Registration is ongoing; tuition fees will be accordingly pro-rated.
Tuition and Payment

1 class/week $1,200
2classes/week $2,250
3 classes/week $3,400
Please note, monthly installments are based on the full tuition cost, it is not a month to month commitment.
All tuition billing at Ballroom Dance Sport Center is set up as automatic billing.
Upon registering for a class, you will be asked to provide credit card information for automatic credit card billing; the payment will be automatically charged between on the 1st of each month, regardless of how many weeks in a month. Any tuition not paid by the 5th of each month will incur a 10% late charge, unless arrangements have been made prior to that date.
If paying in installments by check, postdated checks are to be provided.

MC/VISA Card # _______________________________ Exp. Date___________ ______3 Digit Code on Back______________
Name on Card_________________________________ Full Payment Monthly installments
Billing address for card __________________________________________________________________________________
Signature at the end of this form authorizes Ballroom Dancesport Center to charge your credit card at times indicated and confirms your understanding there are no refunds.
85 Mill Plain Road, Suite R, Fairfield, CT 06824
Cancelation with a full refund is possible through the third class, after that, no refund will be given. Ballroom Dance Sport Center hereinafter referred to as Center is closed on Federal holidays:
New Year's Day
Memorial Day
Independence Day
Thanksgiving Day
Christmas Day

Inclement Weather Cancelation: In the event of inclement weather, the Center will follow the decision of the Fairfield Public Schools. Should Fairfield Public Schools close or have an early dismissal the Center will cancel classes for that evening and will also consider the dancers and faculty who must travel from other towns when making the decision to close in the face of hazardous weather. The most current information about inclement weather closures will be sent by email.

Make-up Classes: It is the student’s responsibility to make up classes, which are missed due to personal conflicts or illness. In case of missing classes due an extended illness or injury a doctor's note is needed to receive credit on the Center’s account. Classes cancelled in conjunction with school closings or inclement weather will not be made up. Classes cancelled by Center will be rescheduled and made up. Missed classes will not be monetarily reimbursed.
Same instructor cannot be guaranteed throughout the duration of package.
Dress code: Proper nice, age appropriate comfortable clothes that don't restrict movement. No street shoes permitted on the dance floor.

Liability: In consideration of the services of Ballroom Elegance Studio, LLC, DBA Ballroom Dancesport Center, its owners, agents, officers and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as "Center"), I hereby agree to release and discharge Center as follows:

1. I acknowledge that my child’s participation in dance instruction activities offered at Center entails known and unanticipated risks that could result in physical or emotional injury, damage to my child, to property, or to third parties.
2. I hereby voluntarily release and agree to indemnify and hold harmless the Center from any and all claims, demands, or causes of action, which are in any way connected with my child’s participation in these activities or use of Center’s facilities.
3. I agree to cover any injury or damage my child may cause while participating in dance instruction activities and to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition my child may have.

Check the box if you wish to receive e-mail notifications about upcoming events. Your information will be kept confidential and used solely for our communications

SIGNATURE ________________________________________________ DATE ___________________________