Student Admission Form

Please fill out the following form to submit your intent to join the upcoming Conservatory class. By submitting this form it does not guarantee your position in the upcoming class. Please review information that is updated on our website and instagram page. If you have any questions, please contact us at theburlesqueconservatory@gmail.com

Name*

First NameLast Name

Stage Name (if already established)

Email*

example@example.com

Phone Number*

Area CodePhone Number

Emergency Contact (Name, Number, Relations)*

Social Media (List any relevant accounts attached to your performer persona, if applicable)

List any shows/companies (amateur or professional) that you have performed in (if applicable)

Which program are you interested in?*

*Must have completed 101 course prior to applying

Payment options*

Full Price (due at first class meeting)2 payment installments (first installment at first class and second scheduled thereafter)4 payment installments (first installment at first class and remaining scheduled thereafter )

What are your expectations for the program?

How did you hear about The Burlesque Conservatory?

Questions or Concerns about the program

In order to reserve your spot in The Burlesque Conservatory class we are requesting a non-refundable reservation fee of $50. This fee will go towards your total course price. Are you able to submit the reservation fee via PayPal before the first day of class?*

YesNeed to speak on this

PayPal Account Email

example@example.com

STUDENT ADMISSION FORM