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Dance * Acrobatics * Summer Class * Summer Camp * Zumba * Yoga * Clogging

Credit Card Draft Authorization Agreement


·         I hereby authorize Xtreme Dance Academy to initiate debit entries online through the Jackrabbit System against my debit or credit card.

·         I agree that all payments concerning Tuition or outstanding balances will be debited from my account. Tuition only will be debit unless my account is in bad standing.

·         I agree that I only have 4 classes before I can drop without having to continue to pay all fee’s such as tuition, costume and concert fee.

·         I agree that if I do not pay concert or costume fees by due date that these will also be debited from my account.

·         I agree that this debit ends with the June recital

·         I agree that if I am not going to continue past the 4 week drop period it is my sole responsibility to inform the studio in a written manner before the 5th Class, either through email or letter stating my student will not be returning. If I do not notify the studio I will be responsible for the remainder of the fees for the session.

I also understand that I am responsible for all other fee’s associated with my student’s enrollment which are as follows:

        Concert Fee - $45-$60 for one student $25-$40 second student

        Costume Fee & Tights - $30-$100 

        Class Attire – Attire needs for whichever class my student attends 

        Parade Sweatshirt - $35-$40

        Finale T-Shirt - $10-$30


Responsible party for payments: __________________________________________   Date: ___________

Dancer or Family Name: ____________________________________

Start Date: _______________________


All credit card information is kept in a locked filing cabinet. Mrs. Jessie has the only access to the card.

Credit Card Number _____________________________________________ Type______________


Exp Mon/Yr ________      Zip Code to card billing address ___________


Name on Card (Printed) ______________________________________


Date to be Debited:   20th       25th      1st               (Circle One)


Sign ________________________________________________  Date_________________

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"What is a dancer.... When we see an acomplished dancer, we see the beauty and ease in which they dance. What we do not see is the things that allowed them to reach this level. A dancer is more than the years of technique. A dancer is determined, confident of others, and a person with strong moral character. They learn to push themselves farther than they thought possible. All of these things make them the dancer they are. My daughter has learned all of these things through the staff and other students at Xtreme Dance Academy. The teachers have taught her how to become a better dancer and person. They have been teachers as well as role models. I could not have asked for a better environment for my child to grow as a person and dancer. They say it takes a village to raise a child. Xtreme has been like a second family to my daughter. She has become a better dancer, as well as more confident, well adjusted, young woman. Dance is more than just a class a couple of times a week. It is a place that allows them to become a strong, caring, and confident young person."

-Lydia Witham