Ballet Arts Registration Form

Student's Name *

First Name Last Name

Age (as of September 1st) *

Birthdate *

Date

Grade

School

Parent/Guardian #1 Name *

First Name Last Name

Parent/Guardian #1 Phone Number *

Area Code Phone Number

Parent/Guardian #1 Email *

example@example.com

Parent/Guardian #1 Facebook Name/Contact

Parent/Guardian #2 Name

First Name Last Name

Parent/Guardian #2 Phone Number

Area Code Phone Number

Parent/Guardian #2 Email

example@example.com

Parent/Guardian #2 Facebook Name/Contact

Student Phone Number

Area Code Phone Number

Student Email

example@example.com

Student/Parent/Guardian(s) Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Financially Responsible Party

First Name Last Name

Financially Responsible Party Phone Number (if different from Parent/Guardian)

Area Code Phone Number

Financially Responsible Party Email (if different from Parent/Guardian)

example@example.com

Financially Responsible Party Address (if different from Student/Parent/Guardian Address)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Please list any allergies or medical conditions your child has that we need to be aware of *

Emergency Contact (other than parent/guardian) *

First Name Last Name

Emergency Contact Phone Number (number other than parent/guardian) *

Area Code Phone Number

Number of years completed at Ballet Arts (for returning students)

Prior dance or gymnastics training (for new students)

Number of years of training

Type of training (for new students)

Ex: ballet, tap, jazz, acrobatics, etc.

Studio or gym where prior dance or gymnastics training occurred (for new students)

I understand and agree to Ballet Arts payment options (credit card, check, cash, PayPal) *

Yes, I agree

I give my permission to process any payments made by check or credit card through the check and credit card processing terminal. *

Yes No

I understand that if I answered NO to the above question, then all payments must be cash or PayPal only. *

Yes, I understood

I understand, if a check is found to have insufficient funds, there is a penalty fee that must be paid to Ballet Arts of $20.00. *

Yes, I understand

I would like to register for:
(class #1)
(day/time)
(studio room)

(class #2)
(day/time)
(studio room)

(class #3)
(day/time)
(studio room)

To register for additional classes please list: EACH class name, class day/time, and studio room.

I understand that my enrollment in class is not guaranteed until my course selection(s) is/are approved by the director and payment has been received. *

Yes, I understand

I understand that once my enrollment is confirmed that the student must have appropriate dancewear and shoes to begin participation in class. *

Yes, I understand

I understand that the observation/waiting areas are closed in the studio for parents/families/guests except for ONE ADULT parent/guardian for our youngest students ages 3-5. *

Yes, I understand

I give my permission for photo usage for studio promotional material (Ballet Arts website, Ballet Arts social media, local/regional news publications) *

Yes, I give permission

I have read and understand the policies in the Ballet Arts manual. *

Yes, I have read and understand the Ballet Policies

Signature

Clear