Name *

First Name

Last Name

Date of birth

MM

DD

YYYY

Phone *

Best way to contact you

(###)

###

####

Parent Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you a returning student?

Jr. Company Member

No - New Student

Yes, Summer

Yes, Fall

Yes, Spring

Previous Dance Experience?

If answered yes, please explain.

Yes

No

Monday Classes

These classes are available on Monday at Dominion Energy Center

4:30 - 6:30 Ballet/Pointe - Inter/Advanced Ages Teen/Adult

6:30 - 7:30 Modern/Contemporary - Inter/Advanced Ages Teen/Adult

Tuesday Classes

These are the classes available on Tuesday at The Glen Allen Cultural Arts Center.

3:30 - 4:30 Spanish Ballet/Flamenco - Ages 3-6 yrs old

4:30 - 5:30 Latin Ballet I- Beg/Inter Ages 6-9 yrs old

4:30 - 5:30 Flamenco II - Intermediate Ages 9-13 yrs old

5:30 - 6:30 Flamenco I - Beg/Inter Ages 6-9 yrs old

5:30 - 6:30 Latin Ballet II - Intermediate Ages 9-13 yrs old

5:30 - 6:30 Salsa - Open Level Ages Teen/Adult

6:30 - 7:30 Flamenco - Inter/Advanced Ages Teen/Adult

Wednesday Classes

These classes are available on Wednesdays at Glen Allen Cultural Arts Center.

4:30 - 6:30 Classical Ballet III - Inter 8-13 yrs old

4:30 - 6:30 Classical Ballet IV - Inter/Advanced Ages 13+

6:30 - 7:30 Hip Hop I - Ages 7-13 yrs old

6:30 - 7:30 Flamenco III - Inter/Advanced Ages Teen/Adult

7:30 - 8:30 Hip Hop II - Open Level Ages Teen/Adult

Thursday Classes

These classes are available on Thursdays at Dominion Energy Center.

4:00 - 5:00 Ballet - Flamenco - Beginners Ages 3-6 yrs old

5:00 - 6:00 Dance Technique - Inter/Advanced Ages Teen/Adult

6:00 - 7:30 Contemporary Jazz - Inter/Advanced Ages Teen/Adult

Emergency Contact *

First Name

Last Name

Emergency Contact Information *

(###)

###

####

Missed Classes *

Missed classes may be made up with any equivalent class of your choice.

I Agree

Photography and Videography Waiver *

I understand that by signing this agreement I give permission for any photos or videos taken of myself or my child, while engaged in activities at the Latin Ballet to be used in promotional materials.

I Agree

Responsibility Waiver *

I am aware the all forms of dance and gymnastics associated with, place unusual stresses on the body and may carry with them the risk of injury. I understand that the Latin Ballet of Virginia or its staff, are not liable in any way for injuries sustained during attendance of the program or any of its functions.

I Agree