Poise Ballet Registration Form

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Please complete this form to enroll your child for classes in school year 2020–2021 (classes begin on August 17, 2020, and end on June 11, 2021). We accept new students on a rolling basis! If you have a question about our classes or enrollment, please use our Contact Form via this link: http://www.poiseballet.org/contact.html. Thank you for your interest in Poise Ballet! ♡

Would you like to have a Free Trial Class?

If YES, please use our Contact Form: http://www.poiseballet.org/contact.html

If NO, please fill out our registration form...

STUDENT INFORMATION ☆

Student Name (First, Last) *

Preferred Nickname (if applicable)

Age *

Date of Birth *

YYYY

Gender *

Academic School *

Grade as of Fall 2021 *

PARENT INFORMATION ☆

Primary Parent Name (First, Last) *

Mailing Address (Street, City, State, Zip) *

Email *

Best Phone Number *

Alternative Phone Number

Additional Parent / Guardian to contact in case of an emergency

Additional Parent / Guardian's Best Phone #

CLASS REGISTRATION ☆

BALLET CLASS REGISTRATION

Please choose which ballet class you're enrolling your child in. Note: * (asterisk) requires prerequisite, or previous dance experience.

Pre-School (3 - 4.5+ yrs old)

Pre-Primary (5+ yrs old)

Primary (6+ yrs old)

Grade 2 (8+ yrs old)

Grade 3 (9+ yrs old)*

Intermediate Foundation (12+ yrs old)*

Other:

FREQUENCY

How many times a week will they attend class?

Once / week - Required for Pre-school, Pre-Primary, Primary

Twice / week - Required for Grade 1 & 2; Optional for Pre-Primary, Primary

Three times / week- Required for Grade 3, 4, 5

Four times / week - Required for Intermediate Foundation

AUXILIARY CLASSES (not available at this time)

Not available at this time. These supplement the above classes, and take place on Saturdays.

For SUMMER DANCE CAMP Students: NO SUMMER CAMP currently

Choose TWO from the following options: 1) which Camp and 2) which dates your child will participate in OR Choose NON-APPLICABLE if registering for the Fall.

PREVIOUS DANCE TRAINING & EXPERIENCE ☆

Has your child taken ballet classes before? *

YES

If YES, at which school and for how long?

Any training in other forms of dance?

Jazz / Lyrical Jazz

Tap

Hip Hop

Hawaiian / Tahitian

Other:

MEDICAL HISTORY ☆

Allergies that Poise Ballet should be aware of: *

None

Other:

Required

Does your child have an illness that requires constant medical follow up? *

YES

If YES, please specify the nature / reasons of their medical follow up:

Does your child have any of the following conditions: *

Epilepsy

Asthma

Heart Condition

None

Other:

Required

If yes, please specify the nature of the condition:

Has your child had any of the following: *

Hospitalization that required 5+ days of stay

Surgery

Fractures

None

Required

★

I have read Poise Ballet's Policies & Procedures and agree to them. *

Please read on our website: http://poiseballet.org/policies-procedure.pdf

Yes, I agree.

Required

Additional comments (optional)

How did you hear about Poise Ballet? *

Submit

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