South Lane Ballet Academy Registration 2018/2019
308 S 10th Street Suite B, CG OR, 97424. 541-912-2080. Southlaneballetacademy.org

Please choose the class(es) you think best suits your experience level as well as interest. Classes are listed by style, then in order by level / age. If we feel you have registered for a class that isn't suitable, we will email you to help you find an alternative.

If a class fails to reach 5 participants, it may be closed due to low enrollment

Monthly tuition -
Mini class - $30
1 regular class - $45
2 regular classes - $85
3 regular classes -$120
4 regular classes - $150
Unlimited for an individual - $150
5 regular classes - $180
Unlimited for a family - $199

Please remit the $40 registration fee to SLBA within 10 days of registration. You can send it to the physical address above, or via PayPal through the address above. If you have an outstanding balance, we will not allow you to re-register until it is cleared up. Thank you!

Student Name
Your answer
Birthdate
Your answer
Address
Your answer
Parents name
Your answer
Home phone, Work phone, Cell phone
Your answer
Email Address (must be included to be a valid registrstion)
Your answer
Emergency Contact phone number
Your answer
Emergency Contact's Relationship to Dancer
Your answer
Primary Care Physician Name & Phone number
Your answer
Insurance Company & Policy Number
Your answer
Special notes regarding dancer: (behaviors, medical, injury, or safety concerns, etc)
Your answer
Ballet
Tap
Jazz
Hip Hop
Modern
By printing my name below I certify that all the information submitted is accurate & true. I also agree to the financial obligations associated with taking classes at SLBA (We do not offers refunds without a doctor's note saying you are unable to finish classes). By submitting this form, I also understand that my child's spot is not officially reserved until the $40 annual registration fee is received.
Your answer
May your dancer be photographed for SLBA marketing / promotions
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