Name *

First Name

Last Name

Date of birth

MM

DD

YYYY

Phone *

Best way to contact you

(###)

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Parent Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Classes *

Which classes are you registering for?

Beginning Ballet (3-5 yrs old)

Beg/Int Ballet (6-9 yrs old)

Int/Adv Ballet (10+ yrs old)

Pointe/Pre-Pointe (approval required)

Turns and Jumps (7+ yrs old)

Ballet Technique (7+ yrs old)

Contemporary (7+ yrs old)

Emergency Contact *

First Name

Last Name

Emergency Contact Information *

(###)

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Misssed 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