Student Pre-Registration Form 25-26

Please fill out the form carefully for student registration. If you have any questions, please email us at kingsportballet@gmail.com

Registration Fee: $40.00 for first student

$45.00 for 2 or more students

Student Name*

First NameMiddle NameLast Name

Birth Date *

MonthDayYear

Gender

Years of Study

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail for School Communications*

example@example.com

E-mail for School Communications #2

example@example.com

Parent or Guardian Name #1*

First NameLast Name

Parent or Guardian Name #2

First NameLast Name

NAME OF PERSON RESPONSIBLE FOR TUITION AND REGISTRATION PAYMENTS*

First NameLast Name

E-mail for TUITION INVOICING*

example@example.com

Phone # Number for Student Inquiries*

An invoice for the registration fee will be sent to the billing email During Summer 2025 after the registration form is submitted.

Best Phone # for Emergency Contact (in case of illness who do we contact)*

Other Phone #

Class Level - Fall 2025/Spring 2026*

If you are unsure of the class level, please reach out to us at kingsportballet@gmail.com

Once the schedule is finalized for the 2025/2026 school year, you will recieve an email with class schedule information. Please make sure your contact info is accurate.

Please indicate if you have an interest in enrolling your student in Contemporary and/or Jazz Class*

YesNo

We often take candid photos of students in class or performances for use in promotions, program books, or social media posts. Any social media posts that use student images are solely used for the promotion of our school, and will be featured only in a professional, business manner.

PHOTO/VIDEO RELEASE - Do you consent to allowing photos or video of this student be used in our promotions, program books, or website/social media posts?*

YesNo

Please Enter any additional information our instructors/staff should be aware of (Dancer Allergies/injuries/Disabilities, Additional Contact Info, Additional Billing Info):

I acknowledge that I understand that participation in dance can be strenuous and challenging and could result in accidental injury. By signing below, I agree to hold harmless Kingsport Ballet and its Artistic Director, Faculty and Volunteer Staff, Board of Directors and all its contractual employees and agents in the event that my child is injured in the course of their activities and classes at Kingsport Ballet.

Signature*

Student Registration Form - Fall 25/Spring 26