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Registration Form
Phone #:
Questions or Comments:
Arabesque Academy of Dancing
"Personalized Dance Training From A 
Professional, Experienced, & Compassionate Staff"

Credit Card #:
Credit Card Exp.:
Number of Classes:
Student Sizing:
School Grade:

There is a $35 Registration Fee per student ($70 per family)
Payment Plan Option:
Payment Date
Tuition Option:
Acceptance of Charges & Fees:
Classes Of Interest:
One Two Three Four Five Six Seven Eight
Child Small Child Medium Child Large Adult Small Adult Medium Adult Large Adult XL
Yes, I would like to use Auto-Pay!
No, I do not wish to use Auto-Pay.
I will Pay In Full! (Discounted Rate)
1st of the Month
15th of the Month
Nine Installments
Full Year Payment
I understand that charges will appear on bank statements as "Belcher Holdings" and/or "Jacob Paul Associates"
I understand that returned charges will be billed a $25 fee