Pre-Registration Form

Student's Name_________________________________

Birthdate______________________________________

Parent(s) Name(s)______________________________

Address________________________________________

City___________________________________________

State________________________ Zip______________

Home Telephone_________________________________

Work Telephone_________________________________

Cell___________________________________________

Email__________________________________________

Does your child play an instrument?____________

Years of study_________________________________

Special Interests_______________________________

Does your child have any special needs that might affect their participation at AAD?________________________ ____________________________________________

Please indicate if you would like:
__________ Scholarship Form and Information
__________ Extended Day Information

Tuition $2500

Registrations are due on March 31, accompanied by a $300 deposit.

Tuition is due in full by May 15th.

A 10% discount is available for the 2nd child in a family.

Please make checks payable to:

Jill Gleim
187 Argilla Road
Ipswich, MA 01938

The $300 deposit should accompany all registrations. It is applied to tuition, and is not refundable after May 15th.