Studio of Ballet Arts
REGISTRATION/RELEASE

Last Name:       

First Name:       

Birth Date:         
 

School:               

Grade:               

Years of Dance:

Address:           

City:                   

State:                     Zip:

Home Phone:    

Mother's Name:

Work Phone:    

Cell Phone:        

Father's Name:   

Work Phone:      

Cell Phone:        

E-Mail Address:

Class(es) Requested:

FOR NEW FAMILIES a $25 non-refundable registration fee is due with the first month’s tuition to reserve a place in the class.

PAYMENTS MUST BE MADE ON OR BEFORE THE FIRST CLASS OF EACH MONTH.
ACCOUNTS MUST BE CURRENT FOR STUDENT PARTICIPATION IN CLASS.

PLEASE MAKE CHECKS PAYABLE TO: STUDIO OF BALLET ARTS Return Check Fee: $30.00

Credit Cards (Visa or Mastercard) are accepted by contacting the studio at (301) 260-2626.

I realize that with any physical activity there is always a risk of accident. I hereby release the Studio of Ballet Arts from any liabilities for injury or damages arising out of personal injury of any kind. I hereby approve my child's/children's participation in this dance program and consent to necessary emergency medical treatment for my child/children on my behalf. To the best of my knowledge, there are no physical or other conditions which will interfere with my child's/children's participation. I have listed any activity related child's/children's diagnosed pre existing medical conditions below.

Medical Conditions: