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2023 BALLET ARTS REGISTRATION FORM
CHILD Last Name
CHILD First Name
Date of Birth
Age (as of Sept. 1)
School & Grade
Parents/Guardians
Facebook Contact
Home Phone
Mom Cell Phone
Dad Cell Phone
Student Cell Phone
Mailing Address
City
State
Zip Code
Parent Email
Financially Responsible Name (if different from above)
Student Email
Financially Responsible Email
Mailing Address
City
State
Zip Code
Medical Condition(s) To Be Aware
Emergency Contact - Not Parent (name/number)
Prior Dance (place & years)
I have dance continually at Ballet Arts for how many years
I give my permission to process any payments made by check or chredit card through he check and credit card processing terminal and the bank and I understand, if a check is found to have insufficient funds, there is a penalty fee tha must be paid to Ballet Arts of $20.00. If this sectin is not signed, te all payments must be cash only. Please Sign
I have read and understand the policies in the Ballet Arts manual and agree to abide by them.
I give mypermissio for any photo or video usage.
Signature
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Date
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