Registration Form

Thank you for filling out the FootNotes Registration form below. All required fields are important for a complete registration.
IMPORTANT INFORMATION: If you decide to register and make payment for a class, a $10 registration fee is non-refundable if you withdraw from a class before or during the start of classes. (The registration fee is included in tuition.) Also please read the Policies/Calendar Page before registering. Thank you :)
(*We now accept credit card payments for all classes but it will include a $3.95 processing fee.*)

The fields marked with (*) are required fields.

*

Student's Name:

* required

*

Date of Birth:

* required

*

Address, City, Zip:

*

Home Phone:

* required

Cell or Work Phone:

Email address:

*

Parent's Name(s):

* required

*

Class Choice:

Discount Code: (Click Coupons/Rewards below for codes)

Coupons/Rewards

*

Final Total:

* required

*

How did you hear about FootNotes?

Referred by:

*

I understand I have full responsibility for my child, for the safety of myself and any other participates, and shall be taken at my own risk. FootNotes and/or Melissa DiGrazio are not responsible for any injuries causes while participating in classes. I also agree to notify FootNotes should any information on this form change.

Yes, I understand and agree

No, I do not agree

*

I give permission for photographs to be taken of my child in class and permission for the photos to be used for promotional fliers, advertisements, and on our studio website.

Yes

No

By submitting this form, I have read and agree to all terms and conditions set forth by FootNotes in the Policies section of this site and on this form.