January 2027 Holiday Classes

January 2027 Holiday Classes

Enrolment Form
Student Name

First NameMiddle NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Student age:
Medical Conditions/Allergies
Contact Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Group Attending
Amount of classes attending
List the date/s attending:
Holiday Private Lesson Special
List your preferred Private Lesson dates:
If you selected NO to Private Lessons type N/A
Are you an aspiring professional ballet dancer?

Student Medical Information
Allergies
Medical Conditions
Current Medications
Additional Information
Does the student have any special needs or accommodations?
(if YES, please list)
Is there any additional information that we should know?
CONSENT AND RELEASE

I hereby authorize the staff of Ballet Express to act on my behalf in case of an emergency involving the student listed above. I understand that every effort will be made to contact me or the emergency contact listed above, but in the event that neither I nor the emergency contact can be reached, I give my consent for Ballet Express staff to seek emergency medical treatment for the student. I release Ballet Express and its staff from any liability in connection with the treatment of the student in case of an emergency.
Parent/Guardian Signature:
Date signed

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Once this form is submitted, we will be in touch with you, to confirm your selected dates and provide you with an invoice.

Kind Regards

Ballet Express Team
Should be Empty:

Parent/Guardians Information