Student Registration
2022 - 2023
This registration form is for the upcoming year starting August 2022.
If you have any questions please call us @ 919-778-0888
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
Mobile Carrier
*
This is used for password recovery
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 3-Up)
Ballet (ages 5-Up)
Tap (ages 5-Up)
Jazz (ages 7-Up)
Pre-Pointe/Pointe (ages 7-Up)
Modern (ages 10-Up)
Irish
Gymnastics (ages 3-Up)
3rd Ballet (ages 10-Up)
Adult Irish
Adult Ballet
Adult Tap
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 3-Up)
Ballet (ages 5-Up)
Tap (ages 5-Up)
Jazz (ages 7-Up)
Pre-Pointe/Pointe (ages 7-Up)
Modern (ages 10-Up)
Irish
Gymnastics (ages 3-Up)
3rd Ballet (ages 10-Up)
Adult Irish
Adult Ballet
Adult Tap
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 3-Up)
Ballet (ages 5-Up)
Tap (ages 5-Up)
Jazz (ages 7-Up)
Pre-Pointe/Pointe (ages 7-Up)
Modern (ages 10-Up)
Irish
Gymnastics (ages 3-Up)
3rd Ballet (ages 10-Up)
Adult Irish
Adult Ballet
Adult Tap
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 3-Up)
Ballet (ages 5-Up)
Tap (ages 5-Up)
Jazz (ages 7-Up)
Pre-Pointe/Pointe (ages 7-Up)
Modern (ages 10-Up)
Irish
Gymnastics (ages 3-Up)
3rd Ballet (ages 10-Up)
Adult Irish
Adult Ballet
Adult Tap
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.
*
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Registration Fee
*
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Registration Fee
$
35.00
Total
$
0.00
Credit Card
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