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Class Enrollment Form-Xtreme Dance Academy


Year: ________Date:__________


Students Name: ___________________________________________DOB ___/___/_______  Age _____


Parent/Guardian:__________________________________     Phone: (H):__________________


Address: ___________________________________              (W):__________________


                 _____________________________________                                 (C): _____________________


Person Responsible for Account ________________________________________

DL# _______________________  Last 4 of Social ______________  DOB _______________

The information above is kept private and confidential. This information is only used for collection purposes on bad debt.


Email: ______________________________________________________________


Emergency Contact (Separate from adults named above)


Name: ________________________________________ Number: ______________________________



How did you hear about us? ______________    Referred By: ______________________________


Does this student have any medical conditions we should be aware of?  Y    N Explain ________________


XDA does not carry medical insurance for its students. Each student is required to be covered by their own family medical policies, and if any injury occurs it is understood that the student’s own policy is their only source of reimbursement. 

Assumption of Risk:It is understood that you are registering for a sport and there is the possibility of injury in the event of an accident.


Registration fee: Required of all New and Returning students. Class space is not held until registration fee is paid.                                                     


Late Fee on Tuition is $15.00 – added to account after the 1st Day of each month

Costumes-Concert Fee-Sweatshirt-Attire for Class / All other Mandatory Fee’s: See Calendar or Online

Service Charge-5% Added to accounts that go over 90 days & are added each month to balance until paid in full.

Recovery Fee’s- You’re responsible for all fee’s the studio may acquire during a collection process.

XDA Reserves the right to terminate any student enrollment due to non-payment if balance is unpaid after 90 days.

Non-Competitive Students are assessed a $25 Drop Fee if you drop after the Enrollment Closing Date: See Calendar

Company students are assessed a $100 Drop Fee After 1st Week of Company Season


 Studio Policies:

· Any dancer causing difficulties in class will be asked to leave at the studios discretion.

· Students are not allowed into class without the proper required attire. This includes; clothing, hair and shoes

· No food, candy, or drinks other than water is allowed into the dance room unless otherwise cleared through the staff.

·  Any item lost or stolen in the studio or parking lot is not the responsibility of XDA.

· All photo’s taken by Xtreme Dance Academy are the property of XDA and can be used for promotional purposes. If you do not allow photographs to be taken of your child please initial here __________

· All students participate in the Mebane Christmas Parade.

· Selected Students attend and participate in the Mebane Dogwood Festival.

· All families are required to read through the Studio Etiquette.





Parent/Guardian Signature: __________________________________ 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