Please register my child for:

       

_____ Discovery Dance I:         1 Week: _____   2 Weeks : _____            

 

_____ Discovery Dance II:    2 Weeks: _____  3 Weeks : _____            

 

_____ Discovery Dance III:    2 Weeks: _____  3 Weeks : _____            

  

_____ Young Dancer Intensive:     1 Week: _____   2 Weeks : _____

_____ Pre-Professional Intensive:     1 Week: _____   2 Weeks : _____

 

 

_____ Open Classes:            Level: ___________  Month(s): ______________________________            

 

Notes:  _______________________________________________________________________________

 

I hereby certify that my child is physically and emotionally capable in participating in this dance program. I hereby release, absolve, indemnify and hold harmless The Ballet Space, and any employee or volunteer, of any accident or injury that may occur as a result of this extra-curricular activity.

Payment/refund policy: I understand that there can be no refunds. The only exception is for serious injury or illness with a doctors note. There is a $25.00 fee for returned checks. Full payment is due with this form in order to hold a space for your child. If you child is on the waiting list, you will be notified and your check will be returned to you.

 

 

Date: ________________ Signature: __________________________________________________________

 

 

 

I give The Ballet Space permission to use any photographs or videos taken of my child in class, rehearsals, and performances for web site and promotional purposes.

Signature: ___________________________________________________________________________

 

 

 

Please list any serious medical conditions or allergies that The Ballet Space should be aware of.

 

Allergies: ________________________________________

 

__________________________________________

 

__________________________________________

 

__________________________________________

 

 

Other: ___________________________________________

 

__________________________________________

 

__________________________________________

 

__________________________________________

 

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To be filled out by The Ballet Space:

 

 

Check # _________ Date: ________ amount: ________

 

Credit Card type (circle one):  Visa or Master Card   Card #: ______________________________ Exp. Date: _________

 

Name as it appears on card: _____________________________________________ CVV#: _____________