GSB Student Registration

Student Registration
Parent/Guardian Name 1 *

First Name Last Name
Parent/Guardian Name 2

First Name Last Name
Email *
example@example.com
Alt Email
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mobile Number *

Area Code Phone Number
Work Number

Area Code Phone Number
Alt Number

Area Code Phone Number
Emergency Contact *

First Name Last Name
Emergency Phone Number *

Area Code Phone Number
Returning family? *

Yes No
Student Name *

First Name Last Name
Age
Gender

Male Female N/A
DOB

Month Day Year
Date
Clothes Size
Student's School
Grade
Medical Conditions / Allergies

Yes No
If Yes, please explain
Class Request 1

Pre-Dance (ages 4-Up) Ballet (ages 5-Up) Tap (ages 5-Up) Jazz (ages 7-Up) Pre-Pointe/Pointe (ages 7-Up) Modern (ages 10-Up) Jazz (ages 7-Up) Irish (ages 3-Up) Gymnastics (ages 3-Up) 3rd Ballet (ages 10-Up)
need to register siblings?

Yes No
Student Name (sibling 2)

First Name Last Name
Age
Gender

Male Female N/A
DOB

Month Day Year
Date
Clothes Size
Student's School
Grade
Medical Conditions / Allergies

Yes No
If Yes, please explain
Class Request 2

Pre-Dance (ages 4-Up) Ballet (ages 5-Up) Tap (ages 5-Up) Jazz (ages 7-Up) Pre-Pointe/Pointe (ages 7-Up) Modern (ages 10-Up) Jazz (ages 7-Up) Irish (ages 3-Up) Gymnastics (ages 3-Up) 3rd Ballet (ages 10-Up)
Student Name (sibling 3)

First Name Last Name
Age
Gender

Male Female N/A
DOB

Month Day Year
Date
Clothes Size
Student's School
Grade
Medical Conditions / Allergies

Yes No
If Yes, please explain
Class Request 3

Pre-Dance (ages 4-Up) Ballet (ages 5-Up) Tap (ages 5-Up) Jazz (ages 7-Up) Pre-Pointe/Pointe (ages 7-Up) Modern (ages 10-Up) Jazz (ages 7-Up) Irish (ages 3-Up) Gymnastics (ages 3-Up) 3rd Ballet (ages 10-Up)
Student Name (sibling 4)

First Name Last Name
Age
Gender

Male Female N/A
DOB

Month Day Year
Date
Clothes Size
Student's School
Grade
Medical Conditions / Allergies

Yes No
If Yes, please explain
Class Request 4

Pre-Dance (ages 4-Up) Ballet (ages 5-Up) Tap (ages 5-Up) Jazz (ages 7-Up) Pre-Pointe/Pointe (ages 7-Up) Modern (ages 10-Up) Jazz (ages 7-Up) Irish (ages 3-Up) Gymnastics (ages 3-Up) 3rd Ballet (ages 10-Up)
I acknowledge that I have read, understand, and accept the Goldsboro School of Ballet policies, dress code, and tuition payment options in the registration packet and have reviewed this information with the participant. Please sign below. *

Clear
Captcha *

Registration Fee *

Registration Fee $ 35.00

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

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