Registration Form
SOUTHEASTERN SCHOOL OF BALLET * 220 Business Park Blvd *Columbia, SC 29203 * (803) 419-5512
Student's First Name *
Your answer
Student's Middle Initial
Your answer
Student's Last Name *
Your answer
Home Address *
Your answer
Home Telephone # *
Your answer
Emergency Telephone # *
Your answer
Parent Information
Mother First and Last Name *
Your answer
Mother Cell Phone *
Your answer
Mother Work Phone
Your answer
Mother Email *
Your answer
Father First and Last Name *
Your answer
Father Cell Phone *
Your answer
Father Work Phone
Your answer
Father Email *
Your answer
Student Information
Please fill in the details below.
What is the student's height? *
Your answer
What is the student's weight? *
Your answer
Date of Birth? *
MM
/
DD
/
YYYY
Years of Ballet Experience?
Your answer
How long have you studied?
Your answer
Do you have any physical problems Southeastern should be aware of? *
If yes to the previous question, please explain. *
Your answer
I understand that I will have to pay $40 upon arrival *
Required
A permanent registration fee of $40.00 is required for one child and an additional $20.00 for sibling(s).
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