SUMMER 2017 Registration Form The Ballet Studio

Student's Name:_____________________________________________________________

Age______ Birth date:_________________School_________________________________

Parent: ___________________________________________________________________

Home Address:_____________________________________________________________

Contact Phone number (during class hours):____________________________________

Phone (home) ________________________Phone (wk/cell) ________________________


Current Class (WS 2017) _____________________________day__________time_________

Class(es) desired: SUMMER 2017


2. ___________________________________________________Day__________time_________

3. ___________________________________________________Day__________time_________

Dance is a physical exercise. As the parent of the above named child, I understand this. 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 performance events

$25.00 registration fee per family for students who were not enrolled in the WS 2017 semester

Total Tuition due (attached) _________________________________Check#________________
Check or cash only. Credit Cards are not accepted.                                   Cash__________________

The Ballet Studio allows payment arrangements upon request. New this semester are a limited number of
work/study positions. In addition, for the SUMMER 2017 semester there are a limited number of full and
partial scholarships offered by The Ballet Studio for qualifying applicants. Contact the Studio Director for more

[  ] Yes, I allow my child’s picture to be used in promotional materials for The Ballet Studio.
[  ] No, I would not like my child’s picture to be used in promotional materials for The Ballet Studio

Parent’s Signature:______________________________________________________________

How did you hear about us? __________________________ Referred by?______________________

Tuition is due prior to your first class and payments may be made at the front desk when you arrive for your
first class
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Class Tuition &