Studio of Ballet Arts Registration/Release Form

* First Name

* Last Name

* School

* Grade		* Birthday

* Address

* City

* State		* Zip

* Phone

* Email

Mother’s Name

Mother’s Work Phone

Mother’s Cell Phone

Father’s Name

Father’s Work Phone

Father’s Cell Phone

* Class Request

Medical Conditions

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 above.

* required

For new families, a $30 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 each month.

Accounts must be current for student participation in class.

Please make checks payable to: Studio of Ballet Arts. Return check fee is $30.00.

All major credit cards accepted. Call the studio at 301-260-2626 for processing.