Student Registration Form

Please enter information for your student in the spaces below.

By submitting this form you agree to the following:

I hereby request that Ballet West allow my (son, daughter, ward hereby referred to as student) to register and fully participate in the Ballet West Academy. I have read and agree to abide by the Ballet West Academy policies and procedures. I understand that my student cannot participate unless tuition is paid in full, and no refunds will be awarded after the first day of class. The Ballet West Academy reserves the right to dismiss students from class for inappropriate behavior.

If my child is chosen to dance in a Ballet West production, they have my permission to participate. I hereby give Ballet West permission to use my child’s image for promotional materials.

Please select the level you are registering for: *

If registering for Ballet Basics, choose class day:

If registering for Preparatory 1, choose class day:

Student's First Name: *

Student's Last Name: *

Student's Middle Initial:

Date of Birth: *

Age as of September 1, 2011: *

Parents/Guardian Names: *

Student Cell Phone:

Mother Home Phone:

Father Home Phone:

Mother Work Phone:

Father Work Phone:

Mother Cell Phone:

Father Cell Phone:

Student Street Address: *

City: *

State: *

ZIP Code: *

Country:

Academic School: *

Grade Level (Fall 2011): *

Parent/Guardian Primary Email: *

Student Email:

Current Dance School:

Guardian Home Phone:

Guardian Work Phone:

Guardian Cell Phone:

Please select all to indicate your agreement with the following statements: *

I hereby state that the student (name listed above) is in good health and physical condition and is capable of participation in this program. I understand that the Ballet West Academy has the right to deny admittance to any student not meeting the standards of the program as it sees fit. I understand that he/she will be dancing at an appropriate level with the following expectations of training time per day: Intermediate 1 – up to 6 hours per day, five days a week; Elementary 2 – up to 5 hours per day, five days a week; Elementary 1 – up to 4 hours per day, four days a week; Foundations 2 –up to 1.5 hours per day, 3 days a week; Foundations 1 –up to 1.5 hours per day, 2 days a week; Pre-Ballet, Primary or KinderDance –up to 1 hour a day, once a week

I attest that he/she is prompt, dependable, attentive and cooperative.

I also agree that I will not hold the Ballet West Academy, Ballet West, or any faculty member of employee liable for injuries sustained or illnesses contracted while he/she is a student at the Ballet West Academy. I also agree not to hold these parties responsible in the event that my son/daughter engages in inappropriate conduct or becomes involved in any activity or with any persons not associated with the Ballet West Academy or its scheduled program and that Ballet West Academy has the right to send him/her home for inappropriate conduct. I further attest that the information contained in this application is correct to the best of knowledge. In addition, I have read the policy and fee statement and agree to comply.

May we include your contact information in the student directory: *

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Student Registration Form