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Parent 1: First and Last Name
*
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Parent 1: Address
*
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Parent 1: Email address
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Parent 1: Alternate Email address
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Parent 1: Home Number / Cell Number
*
(please provide area code)
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Parent 1: Employer/Business Name
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Parent 2: First and Last Name
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Parent 2: Address
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Parent 2: Home Number / Cell Number
(please provide area code)
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Parent 2: Email address
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Parent 2: Employer/Business name
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Student: First and Last Name
*
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Gender
*
Female
Male
Home Address
*
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City/State/Zip
*
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Age
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Date Of Birth (Month/Day/Year)
*
(i.e. 1/1/16)
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Dance School
(previous training, if applicable)
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Years of Dance Training
(if applicable)
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Academic School
*
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Grade
*
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Student Email
(optional)
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Student Contact Number
(optional)
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Emergency Contact: First and Last Name
*
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Emergency Contact: Relation to Student
*
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Emergency Contact: Contact Number
*
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Student Health Care Provider
*
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Student Health Care Provider Contact Number:
*
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Classes of Interest
(Please check all that apply)
Friday Prima
Saturday Prima AM
Friday Intro to Ballet Technique
Saturday Intro to Ballet Technique AM
Saturday Intro to Ballet Technique PM
Prep to Ballet Tech 1 (Tues/Thurs)
Prep to Ballet Tech 1 (Wed/Sat)
Ballet Tech 1 (Mon/Sat)
Ballet Tech 1 (Wed/Sat)
Ballet Technique 1A (Tues/Wed/Fri)
Ballet Technique 2 (Mon/Thurs/Sat)
Ballet Technique 3 (Tues/Thurs/Sat)
Ballet Technique 4 (Mon/Tues/Wed/Fri)
Ballet Tech 3 Pointe (Tues/Thurs/Sat)
Ballet Tech 4 Pointe (Mon/Tues/Wed/Fri)
Drop-In Technique Classes (Mon/Tues/Wed/Thurs/Sat)
Beginning Pointe (Thurs)
Other:
Option 1
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How did you hear about us?
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Registration fee of $25.00 due upon enrollment into classes/programs unless otherwise noted. No registration fee for drop-in classes. Tuition is subject to change.
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