Student Registration Form
Fill out the form carefully for registration
Student Name
*
First Name
Last name
Current Address
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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Day
Please select a year
2024
2023
2022
2021
2020
2019
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2015
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2012
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1924
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1921
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Year
Gender
*
Please Select
Male
Female
N/A
Phone Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Do you take any medication or have any allergies/medical condition that we should be aware of? if yes, please explain.
If you are pregnant and/or have any chronic injures, please seek advice of a doctor as well as a written note from them granting you permission to exercise and engage in ballet classes
Which class are you registering for?
*
Please Select
Online ballet Classes
Studio Ballet Classes
Private Ballet Classes
Hiphop Classes
Choreography Class
VERY IMPORTANT!!! If the student is a minor (below 18yrs), the guardian is required to fill out this section
All fields are required if the student is a minor
Guardian
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Does your child/children take any medications, or have any allergies/medical conditions we should be aware of? if yes, please explain.
This is to keep us informed in case of emergencies during classes.
Additional Emergency Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
How did you hear about Leotard ballet?
Please verify that you are human
*
Submit Application
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