SUMMER 2019 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) ________________________


New Student [   ] yes

Returning Student [  ]

WS 2019 prior class attended  _____________________________day__________time_________

Class(es) desired: Summer 2019


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 2019 semester

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

[  ] 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