Youth Program 2017 Registration Form
Welcome to Ramon Moreno School of Ballet's Youth Program 2017 Registration. Please answer the following questions. Thank you!
Email address *
Youth Program Level
Level Choice *
Student's Information
OrlFirst Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Address
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Student's Cell Number if any
eg: 650-304-1909
Your answer
Student's Email if any
Your answer
Parent / Guardian Information
Parent / Guardian 1 Name *
Your answer
Parent / Guardian 2 Name
Your answer
Primary Contact Number *
eg: 650-304-1909
Your answer
Primary Contact Number Type *
Secondary Contact Number
eg: 650-304-1909
Your answer
Secondary Contact Type
Email Address 1 *
Your answer
Email Address 2
Your answer
Emergency Contact
Please provide any emergency contact other than the parents / guardians above
Name *
Your answer
Phone Number *
eg: 650-304-1909
Your answer
Relation to Student
Your answer
Medical Information
Please provide essential medical information about the student
Allergies
Your answer
Special Needs (including medication)
Your answer
Primary Physician's Name *
Your answer
Primary Physician's Number *
Your answer
Education
Academic School Name
Your answer
Grade Level as of September 2017 *
Your answer
Previous Ballet Training
How many years has the student been dancing *
Your answer
How many hours does the student dance per week *
Your answer
Female Only: How long has the student been on pointe
Your answer
Which ballet school does the student attend in the previous year *
Your answer
How long has the student been at the ballet school *
Your answer
If less than a year, please list previous ballet school(s) attended and duration at the school(s) in the past year
Your answer
Notes to parents / guardians
Please remember to sign the waiver on the first day and be on time.

To secure your spot in the youth program, we ask for $500 deposit that will be due on July 11, 2017.

Payment Options:

Cash or Personal check

Checks must be mailed to
Ramon Moreno School of Ballet
935 Industrial Ave
Palo Alto, CA
94303
There will be a $30 fee for returned checks.

Acknowledgement *
Required
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