Ballet Intensive Registration Form
Please fill out the form and send us back.
Student's Name
*
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Parent's Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Intensive Dates:
June 30 - July 17, 2026 (full 3 weeks)
Days
Weekly
Please fill the dates you will attend:
Date
Signature
Please list any allergies or medical conditions your child has that we need to be aware of
*
Should be Empty: