Everyone Can Dance: Ballet for All Abilities
PRE-REGISTRATION FORM
Adult's Name
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First Name
Last Name
Student's Name
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First Name
Last Name
Child's Date of Birth
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Month
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Day
Year
Date
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
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example@example.com
Does the student have a formal diagnosis?
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Yes
No
If yes, please specify:
Is the student currently in a medication plan?
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Yes
No
If yes, please specify:
Please explain any allergies/diet considerations:
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Please explain any additional medical information:
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Is the student senstive to touch?
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Yes
No
Is the student sensitive to light?
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Yes
No
Is the student sensitive to sound?
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Yes
No
Does the student have any behavioral issues?
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Yes
No
If yes, please describe the behavior and its periodicity:
Is the student currently taking physical, occupational, behavioral or another type of therapy?
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Yes
No
If yes, please specify the type of therapy and its aim.
What type of behavioral intervention method do you currently use at home?
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What happens if your child is separated from you?
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What situations does the student like to avoid?
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Please list the students favorite activities!
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Please list the students favorite character, music, food, favorite color!
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What are your expectations for the program and in which areas would you like to see your student improve?
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Policies and Procedures
Students are expected to wear appropriate attire for each class. Hair must be tied back and shoes should be the correct size.
It is important to be on time for class, with the student ready to dance.
Parents must remain outside the studio and may only enter the classroom when requested.
Food, drinks, and chewing gum are strictly prohibited inside the classroom.
River Oaks Dance will make decisions regarding behavior and teaching methods and reserves the right to deny services.
I have read and agree to the policies and rules stated here, and I commit to following them.
Signature:
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Date
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Month
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Day
Year
Date
Press consent: I give my authorization for River Oaks Dance to use my voice, photographs, and words, or those of my child, in the media for the purpose of promoting the institution's objectives. Child's name will not be used.
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Yes
No
Signature:
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Date
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Month
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Day
Year
Date
SUBMIT
Should be Empty: