SSB Registration Form
SOUTHEASTERN SCHOOL OF BALLET * 220 Business Park Blvd *Columbia, SC 29203 * (803) 419-5512
Student's First Name *
Student's Middle Initial
Student's Last Name *
Home Address *
Home Telephone # *
Emergency Contact Number # *
Parent Information
Legal Guardian/Mother First and Last Name *
Mother/Legal Guardian Cell Phone # *
Mother/Legal Guardian Work Phone #
Mother/Legal Guardian Email *
Father/Legal Guardian First and Last Name *
Father/Legal Guardian Cell Phone # *
Father/Legal Guardian Work Phone #
Father/Legal Guardian Email *
Student Information
Please fill in the details below.
Date of Birth? *
MM
/
DD
/
YYYY
Years of Ballet Experience?
How long have you studied?
Do you have any physical problems Southeastern School of Ballet, LLC should be aware of? *
If yes to the previous question, please explain. *
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