Supplimentary Training Program
Enrolment Form
Student Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Student age:
*
Medical Conditions/Allergies
*
Contact Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Name of current School of regular training
*
name of school
Has your child’s current Principal or Director granted permission for them to participate in our Supplementary Vaganova Training Program?
*
YES
NO
Which level will your child be in?
*
Please Select
Elite 1 (10yrs - 11yrs)
Elite 2 (11yrs - 12yrs)
Elite 3 (12yrs - 14yrs)
Elite 4 (14yrs - 15yrs)
Elite 5 (15yrs +)
What are you hoping to achieve from our classes?
eg: improve my technique, get more training hours in, learn the Vaganova Method etc
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Parent/Guardians Information
Parent/ Guardian's Full Name
*
First Name
Middle Name
Last Name
*
Parent
Guardian
Relationship to student
*
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Other information
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Emergency Contact Information
Full Name
*
First Name
Middle Name
Last Name
Relationship to student
*
Occupation
Contact number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Other Information
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Student Medical Information
Allergies
*
Medical Conditions
*
Current Medications
*
Additional Information
Does the student have any special needs or accommodations?
*
(if YES, please list)
Is there any additional information that we should know?
*
CONSENT AND RELEASE
I hereby authorize the staff of Ballet Express to act on my behalf in case of an emergency involving the student listed above. I understand that every effort will be made to contact me or the emergency contact listed above, but in the event that neither I nor the emergency contact can be reached, I give my consent for Ballet Express staff to seek emergency medical treatment for the student. I release Ballet Express and its staff from any liability in connection with the treatment of the student in case of an emergency.
Parent/Guardian Signature:
*
Date signed
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
This form will be kept on file by Ballet Express, and should be updated annually or as necessary to ensure that the emergency contact and medical information is current.
Submit
Submit
Should be Empty: