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Student Registration Form
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Email
*
Your email
Please select the program you want to register:
*
Private lesson
Pre-ballet (Age 3-5) Fridays
Ballet - PTP 0 (Age 6-7)
Ballet - PTP 1 (Age 8-9)
Ballet - PTP 2 (Age 10-11)
Ballet - PTP 3 (Age 12-14)
Ballet - PTP 4 (Age 15-18)
Adult Ballet
Adult Conditioning
Adult Choreography (Group Dance)
Adult Pointes Technique
Required
Student - First Name
*
Your answer
Student - Last Name
*
Your answer
Student - Gender
*
Female
Male
Female
Male
Student - Date of Birth
*
MM
/
DD
/
YYYY
Parent - First Name (for adults put your name)
*
Your answer
Parent - Last Name (for adults put your name)
*
Your answer
Student - Allergies
*
YES
No
YES
No
Parent Cell Number (Adult Student cell)
*
Your answer
Address
*
House Number/ Flat Number
Your answer
Address
*
Street
Your answer
Address
*
City
Your answer
Address
*
Posta Code
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Cell Phone
*
Your answer
Ballet Schools attended before
*
Your answer
A copy of your responses will be emailed to the address you provided.
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