TO REGISTER SIMPLY PRINT THE PAGE BELOW AND SEND IN THE FORM TO THE ADDRESS AT THE BOTTOM OF THE PAGE OR BRING IT IN TO THE STUDIO AT 3300 YONGE ST.
REGISTRATION FORM Tandem STUDIOS DATE:_____________ NAME:________________________AGE:__________DOB:__________ PARENT’S NAME:________________________ HOME NUMBER: ________________ CELL: _______________ ADDRESS:_______________________________ ________________________________ EMAIL:__________________________________ (Please note Studio updates will be sent to you via email regularly ) EMERGENCY CONTACT: NAME:______________ PHONE #:_________________ CLASS TYPE WEEKDAY TIME PAYMENT METHOD Please note: Payment must be made using 4 post dated cheques or pre-authorized credit card payments. Payment dates are 1) Upon registration. 2) 15Oct10 3) 05Dec10 4) 01March11 Amount of each installment: ___________________ Post Dated Cheques:______ Cheque numbers: 1) 2) 3) 4) Pre-Approved credit card payment: Visa____ M/C ____ Credit card Number: _________________ Exp.Date: _____ I give Tandem Studios permission to put through payments as calculated above on my credit card. Payments will be put through on the payment dates as listed. ________________________ Signature _________________ Printed Name Yearly fee paid in full: ________ Pymt. Method/Date: _________ 1. Any classes cancelled by the registrant/parent or cancelled due to “Acts of God” are non-refundable. ___ (pls. initial) 2. Any class cancelled by Tandem Studios due to unforeseen circumstances such as illness/injury etc. will be made up by the studio with a “make-up” class. ___ (pls. initial) 3. If you wish to withdraw from a class, written notice must be given to Tandem Studios at least 3 weeks prior to the next payment due date (a $20 administration fee applies). Any class cancellations requested after said 3 week notice will be subject to a fee of $65 ___ (pls.initial) PLEASE LIST ANY ALLERGIES:________________________________ PLEASE LIST ANY PERTINENT MEDICAL CONDITION:___________ _____________________________________________________________ DATE:__/__/__ SIGNATURE:____________ WITNESS:___________ SEND FORMS TO : 83 ISABELLA ST. SUITE 317 TORONTO ONT. M4Y-1N7