Student Registration Form for Ballet in the Bay

Name

First NameLast Name

e-mail

Primary Phone

Area CodePhone Number

Work Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

Relationship to Student

Student Name

First NameLast Name

Date of Birth

MonthDayYear

Age

Class Weekday, Time, Instructor Preference

Any health conditions?

If yes, please name

New or Returning Student?

Student Name

First NameLast Name

Date of Birth

Date

Age

Class Weekday, Time, Instructor Preference

Any health conditions?

If yes, please name

New or Returning Student?

Paying for the-

Total Tuition

Family Discount

10% off total for 2 or more joining

Grand Total

Notes:

Today's Date

Date

By checking 'I Agree' below and submitting this form, you, the Parent or Guardian of the above student(s), agree to release ballet in the Bay, including instructors and assistants from liability for any and all injuries which may occur while training, practicing, performing, or during any studio event or activity. You also agree that you are responsible for health and accident insurance and any medical costs incurred due to injury. You give permission for emergency medical transportation and treatment of your student(s) at your expense should the need arise. You also give your permission for the public display of any studio visual images that your child may appear in.

please select

Payment and a current account is required to secure a place in each class. Class sizes limited.

please pay direct to:

Account name-ballet in the bay Bank: ANZ
Account number: 06-0629-0086198-00 reference: name of child and ‘ballet

Registration 2020

Parent/Guardian Info

Student 1 Info

Student 2 Info

Totals

Terms and Conditions