Student Registration
2024 - 2025
This registration form is for the upcoming year starting August 12, 2024. 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
Please Select
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California
Colorado
Connecticut
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District of Columbia
Florida
Georgia
Hawaii
Idaho
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Indiana
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Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Mobile Number
*
Work Number
Alt Number
Emergency Contact
*
First Name
Last Name
Emergency 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 3-4)
Ballet (ages 5-Up)
Tap (ages 5-Up)
Jazz (ages 7-Up)
Pre-Pointe(ages 7-up)
Pointe (Upon recommendation ONLY)
Modern (ages 10-Up)
Irish
Gymnastics (ages 3-Up)
Friday 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 3-4)
Ballet (ages 5-Up)
Tap (ages 5-Up)
Jazz (ages 7-Up)
Irish
Pre- Pointe (Ages 7-up)
Pointe (Upon recommendation ONLY)
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 (ages 7-Up)
Pointe (Upon Recommendation ONLY)
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 (ages 7-Up)
Pointe (Upon recommendation ONLY)
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.
*
Registration Fee
*
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Registration Fee
$
35.00
Credit Card
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