Poise Ballet Registration Form
Please complete this form to enroll your child for classes in school year 2019–2020 (classes begin on September 3, 2019, and end on June 19, 2020). 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?
STUDENT INFORMATION ☆
Student Name (First, Last) *
Your answer
Preferred Nickname (if applicable)
Your answer
Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Academic School *
Your answer
Grade as of Fall 2019 *
PARENT INFORMATION ☆
Primary Parent Name (First, Last) *
Your answer
Mailing Address (Street, City, State, Zip) *
Your answer
Email *
Your answer
Best Phone Number *
Your answer
Alternative Phone Number
Your answer
Additional Parent / Guardian to contact in case of an emergency
Your answer
Additional Parent / Guardian's Best Phone #
Your answer
CLASS REGISTRATION ☆
BALLET CLASS REGISTRATION
Please choose which ballet class you're enrolling your child in. Note: * (asterisk) requires prerequisite, or previous dance experience.
FREQUENCY
How many times a week will they attend class?
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? *
If YES, at which school and for how long?
Your answer
Any training in other forms of dance?
MEDICAL HISTORY ☆
Allergies that Poise Ballet should be aware of: *
Required
Does your child have an illness that requires constant medical follow up? *
If YES, please specify the nature / reasons of their medical follow up:
Your answer
Does your child have any of the following conditions: *
Required
If yes, please specify the nature of the condition:
Your answer
Has your child had any of the following: *
Required
I have read Poise Ballet's Policies & Procedures and agree to them. *
Required
Additional comments (optional)
Your answer
How did you hear about Poise Ballet? *
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