Oakley Ballet Center Registration
Oakley Ballet Center values your privacy and therefore takes necessary steps to safeguard your information. Oakley Ballet Center does not share your information with third parties without your permission. Information submitted through this form is encrypted for secure data transmission. Please contact info@oakleyballet.com with any questions or concerns. Thank you.
Student First Name *
Your answer
Student Last Name *
Your answer
Student Level
Consult registration email for level placement. Leave blank if you have not received placement information from Oakley Ballet Center.
Academic School *
Your answer
Grade Level *
Birthdate
MM
/
DD
/
YYYY
Street Address *
Your answer
City *
Your answer
ZIP Code *
Your answer
Parent/Guardian 1 Name *
Your answer
Parent/Guardian 1 Phone *
Your answer
Parent/Guardian 1 Email *
Your answer
Parent/Guardian 2 Name
Your answer
Parent/Guardian 2 Phone
Your answer
Parent/Guardian 2 Email
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Medical Conditions or medications taken?
Your answer
I have read and understood Oakley Ballet Center’s studio and tuition policies. *
Consult studio information packet for complete policies.
Required
I hereby authorize and give full consent to Oakley Ballet Center to publish and copyright all Oakley Ballet Center photographs and/or video in which I/my child/my ward appears. I/my child/my ward further agree that Oakley Ballet Center may transfer, use or cause to be used, these photographs and/or video in brochures, newsletters, advertising web sites, posters, displays, slide shows, videotapes catalogs, and like publications or literature without limitations or reservations.
I further permit Oakley Ballet to include my/my child's/my ward's quotes in any and all newspaper/newsletter press releases, educational magazine articles, professional periodicals, and our web site. There is no limit as to how many times an article or quote may be reproduced.
In consideration of the Oakley Ballet Center providing the undersigned with lessons, the undersigned acknowledges: The Oakley Ballet Center does not carry liability insurance for injuries to the person or damages to personal property occurring during the course of said lessons and further agrees that neither the Oakley Ballet Center nor its principals, agents nor employees shall be liable for any injuries to the person or damage to personal property of the undersigned or of any other person whomsoever, occasioned by, directly or indirectly, arising out of any act or omission or alleged act or omission of the Oakley Ballet Center or its principals, agents, or employees in conjunction with the said lessons being so provided, and further hereby waives all rights to bring action at law or in equity to recover damages to person or property arising of or in any manner connected with said lessons. *
Required
I grant Oakley Ballet Center permission to share the information submitted through this form with Footworks Youth Ballet for the purposes of production planning and organization.
Submit
Never submit passwords through Google Forms.
This form was created inside of Oakley Ballet Center. Report Abuse - Terms of Service