Client Enrollment Form

Client Enrollment Form

Please complete all information including your personal information and the class/classes you are enrolling/enrolled in.
Your information
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Emergency Contact Name*

First NameLast Name
Emergency Contact Relationship*
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Your membership
Membership Level
As a Silver member, you can enrol in 1 class per week as your 'home base'. Check one class to nominate as your 'home base' class.
As a Gold member, you can enrol in 2 class per week as your 'home base'. Check two classes to nominate as your 'home base' class.
As a Platinum member, you can enrol in 3 classes per week as your 'home base'. Check three classes to nominate as your 'home base' class.
As a Diamond member, you can enrol in 4 classes per week as your 'home base'. Check four classes to nominate as your 'home base' class.
As an Ultimate member, you can enrol in 5 classes per week as your 'home base'. Check five classes to nominate as your 'home base' class.

You can still attend unlimited classes, but you can only enrol in a maximum of five, in order to keep all classes financially viable.
Your enrolment
MondayTuesdayWednesdayThursdayFridaySaturday
You are enrolling for:
Ballet L1BBallet L2APre-pointe/Demi PointeJazz L3AJazz L4
Ballet Mature ProgressingBallet L4+Ballet Repertoire L3+Progressing PointeTap L1ATap L2DTap L2ATap L4
Jazz Mature ExperiencedJazz Mature BeginnerContemporary L4Jazz L4Jazz L2 (formely mature Jazz )Jazz L3
Ballet L2ATap Mature ExperiencedContemporary L2ATap Tech L2+Jazz L2ATap L3
Ballet Barre L2Ballet Barre L3Jazz Mature ExperiencedJazz Mature Progressing
Contemporary L2Contemporary L3Tap L3Ballet L2ABallet L3CBallet L4Ballet L6Early PointeExperienced Pointe
Should be Empty:

Client Enrollment Form

Your information

Your membership

Your enrolment