registration form | Ballet Arts

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

Date