Class Registration Form

Select the Class you would like to register for:*
Day you would like for Mommy and Me Class*
Day you would like for Level 1 Ballet*
Day you would like for Level 2 Ballet*
Day you would like for Level 3 Ballet*
Name*

First NameLast Name
Birthday*

MonthDayYear
Date
Participant's Name*

First NameLast Name
Participant's Birthday*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Example: (555) 555-5555
What is your unisex t-shirt size?*
Participant's Photo*

Browse Files

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How did you hear about us?*

EmailFacebookInstagramFriendAd in Pickleville Playhouse ProgramOther
May we ask who your your friend was that referred you?
Parent/Guardian Info
Parent/Guardian Name*

First NameLast Name
Cell Phone Number*
Example: (555) 555-5555
Email Address*
example@example.com
Do you want to add an emergency contact?

YesNo
Emergency Contact Info
Emergency Contact Name*

First NameLast Name
Relationship to Participant*
Phone Number*
Example: (555) 555-5555
Please read the Studio Waiver located here: https://bit.ly/2P3Aisk
Please select YES if you have read the Studio Waiver (linked above).*

YES
Please SIGN below for a release of liability as fully explained in the Studio Waiver (linked above).*
Please read the 90 Day Membership Contract located: here
Please select YES if you have read the 90 Day Membership Contract (linked above).*

YES
Please SIGN below to agree to the 90 Day Membership Contract (linked above).*
One Last Step After This!

Press the Submit Button to be taken to the appropriate payment page!!! You must complete and submit your payment on the next page for your registration to be considered complete.
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