Student Registration Form for Ballet in the Bay

Ballet in the Bay

Registration 2021
Parent/Guardian Info
Name*

First NameLast Name
e-mail*
example@example.com
Cell Phone
Primary Phone*
Relationship to Student*
Student 1 Info
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Current age
Class, location, weekday, time
Any health conditions?

YesNo
If yes, please name
New or Returning Student?*

Returning StudentNew Student
Notes:
Student 2 Info
Student Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Current age
Class, location, weekday, time
Any health conditions?

YesNo
If yes, please name
New or Returning Student?

Returning StudentNew Student
Notes:
Totals
Paying for the-

TermYear
Total Tuition
please refer to newsletter for fee amount
Family Discount
10% off total for 2 or more joining
Grand total
Terms and Conditions
Today's Date

MonthDayYear
Date
By checking 'I Agree' below and submitting this form, you, the Parent or Guardian of the above student(s), agree to release ballet in the Bay, including instructors and assistants from liability for any and all injuries which may occur while training, practicing, performing, or during any studio event or activity. You also agree that you are responsible for health and accident insurance and any medical costs incurred due to injury. You give permission for emergency medical transportation and treatment of your student(s) at your expense should the need arise. You also give your permission for the public display of any studio visual images that your child may appear in.
please select*

I agreeI don’t agree
Payment when enrolling is required to secure a place in each class. Class sizes limited.

please pay direct to:

Account name-ballet in the bay Bank: ANZ
Account number: 06-0629-0086198-00 reference: name of child
$90 kinder class | $108 pre primary and primary | $120 inter | $150 teen and adult
Should be Empty:

Ballet in the Bay

Parent/Guardian Info

Student 1 Info

Student 2 Info

Totals

Terms and Conditions