Offline Registration

Please Print and Bring In

Registration Form

Student’s Name_________________________________________________________________

Parents Name (If under 18) ________________________________________________________ Address___________________________________City___________________Zip___________ Home____________________ Mom's Cell_________________
Dad's Cell________________Email_______________________ Birthdate_______________Age_____School_________________________________Grade____

Years of training: Ballet____Modern____Jazz____Tap____Hip-Hop____Other________________

How did you hear about us? _______________________________________________________

I give permission for MHLV Dance to use photographs and/or video images of me/my child for advertising and marketing purposes.

__________________________ ____________ __________________________ ____________

Student's Signature Date Parent's Signature Date

Class Tuition

__________________________________________ 1 class/week $48.00 month, $192 for spring semester

Class Day Time

__________________________________________ 1 drop in class $15 per class

Class Day Time

Tuition and Payment Information

Registration Fee (Non-refundable) $___________Spring semester tuition $___________

$20 Individual/$30 Family Total

Option to pay in 4 installments

Monthly Tuition $_____________ 1st Month Tuition $__________ Check here for Automatic Draft ___

Total Due Now $___________

$10 LATE FEE AFTER THE 10TH OF EACH MONTH

MHLV Dance, LLC~7353 Braeswood, Houston, Texas 77071~(713)-927-4014