2020-2021 REGISTRATION
Zamuel Ballet School
Student Name
First Name
Last Name
Parent Name
First Name
Last Name
Parent Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number
-
Area Code
Phone Number
Alternate Phone Number
-
Area Code
Phone Number
Email
example@example.com
Age
Date of Birth
-
Month
-
Day
Year
Male
Female
Pointe
Yes
No
Dance History (schools and years studied)
I am registering for
Pre-Ballet
Beginner
Elementary
Intermediate
Advanced
Adult
Initial Payment
Please charge my credit card
I will bring payment to the school
Please call the school on (719) 570-1441 if you would like help in calculating payment
I am paying $ Registration Fee
I am paying $ First Month's Tuition Fee
Optional Monthly Automatic Payment
Yes, please charge my card for tuition at the beginning of each month
No
Name on Card
Type of Card
Billing Zip Code
I understand that the Zamuel Ballet School is not responsible for accidents, injury, or illness that may occur on Zamuel Ballet School premises, or during organized rehearsals or performances at theaters or other locations. I also understand that photos and video may be taken of students during Zamuel Ballet School events. I give permission for the above student's likeness to be used in Zamuel Ballet School materials. Parents and students are NOT authorized to share or publish images or video of other students. Check payable to: Zamuel Ballet School. We also accept major credit cards.
I Agree
I Do Not Agree
Today's Date
-
Month
-
Day
Year
Submit
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