Student's Name: _________________________________________________________________________

Age______ Birth date:_____________________________School________________________________ __

Parent: ________________________________________________________________________________

Home Address: _________________________________________________________________________

Contact Phone number
(during class hours):__________________________________________________

Phone (home) ___________________________Phone (wk/cell) __________________________________

*The Ballet Studio allows payment arrangements upon request. New this semester are a limited number of work/study positions. In addition,  the
Ballet Studio offers a limited number of full and partial scholarships each semester  to qualifying applicants.  Contact the Studio Director for more

* Dance is a physical exercise. As the parent of the above named child, I understand that. By signing below and/or making payment for classes
and workshops, I agree that the Ballet Studio owner(s) and staff are not responsible for injuries occurring by reason of participation in classes,
workshops or other studio events. And, The Ballet Studio owner(s) and staff are not liable for costs due to injury.  

I have read and agree to the
policies and procedures as posted on The Ballet Studio website.

Parent's signature/ Signature:_____________________________________________________________________

The Ballet Studio 2107 Mt. Vernon Ave.  Alexandria Virginia 22301 703-379-1649  SU 2015
[  ]Yes, I allow my/ my child’s picture to be used in promotional materials for The Ballet Studio.

[  ]
No, I request that my/ my child's picture not be used in promotional materials for The Ballet Studio
THE BALLET STUDIO  Fall 2015 Registration Form
September 12th - December 18th
Please print (LANDSCAPE) and return on first day of classes
Online pre registration is required for all classes
Class(es) desired:                                                               Day                                           Tuition Due

1.___________________________________    Day____________________          ___________________

2. ____________________________________ Day____________________           ___________________

3. ____________________________________Day_____________________          ___________________

Total Tuition due ________________________________
classes run 9/12-12/18

45 minute classes -- $240.00

Creative Movement
Intro to Dance Ballet  
Intro to Dance Tap I
Jazz Modern
Hip Hop

60 minute classes  --  $247.50

Ballet I
Ballet II
Tap II   
Tap III - Adv.
Jazz II

1 hour 15 mins. classes -- $255.00

Ballet IIIA  w/ pre pointe Jazz Adv.
Adult Beginner/Adv. Beg. Ballet

Ballet  two times per week:
Ballet II and Ballet IIIA w/prepoint -- $450.00

Ballet III w/prepoint and Ballet IIIB w/out pointe  -- $450.00

Ballet w/ pointe two times per week:
Ballet IIIA pre pointe & Ballet IIIB pointe  --  $500.00   

Ballet IIIB pointe & Ballet IIIC  pointe  -- $545.00

Ballet w/ pointe three times per week:
Ballet IIIA+ Ballet IIIB  + Ballet IIIC  w/pointe -- $745.00

Teen/Adult Ballet IIIB Adv. Beg. - plus Pointe- $275.00
(Once a week option--w/instructor approval- minimum 3 years pointe)

Teen/Adult Ballet IIIC  Adv. Beg. - plus Pointe- $275.
(Once a week option--w/instructor approval- minimum 3 years pointe)

Triple Threat Pre Professional Program:
Ballet, Jazz and Tap; (or any 3 classes per week-
excludes pointe) - $665.00

Adult Single Class/Drop in - $20

Adult Adv. Ballet w/Pointe Single class option-
w/instructor approval- minimum 3 yrs pointe

Adult Class Card:  Adult Ballet or Adult/Teen Jazz  -- 7 class card  $130.00 (excludes pointe)
expires 10wks after purchase

Adult Class Card: Tap - 7 class card $125  expires 10wks after purchase