REGISTRATION FORM 2010-2011 SEASON

Registration for classes at Bristol Ballet may be mailed, emailed, or faxed to the studio. There is a $20.00 registration fee per student, due at the time of registration. Email: info@bristolballet.org; fax: 276-669-9330)

Tuition is based on an annual fee and may be paid monthly, by semester, or annually.  The regular annual season is August through May. Any summer programs will have a separate fee. Tuition is due on the first of each payment period (month, semester, or season). Payments received after the tenth day of the due date will be subject to a $10.00 late fee. Delinquent accounts will be reviewed by the Board of Directors and may place the student in jeopardy of continuance of classes and performance opportunities.

Please make checks payable to Bristol Ballet and write the student’s name in the memo portion of the check. Please note that our mailing address is Bristol Ballet, PO Box 699, Bristol, VA  24203.

(  ) New student                                                                                                      (  ) Returning student

If new student, how did you hear about Bristol Ballet? __________________________________________

Student’s name: _____________________________________Current age: ______Birth date: ____________

Address: __________________________________________City: _________________________________

State: _______________Zip Code: ________________          E-Mail address:_________________________

Child’s clothing size:_________________________ Child’s shoe size:______________________________

Mother’s name:_____________________________Father’s name:________________________________

Home telephone:____________________________

Mother’s cell phone:_________________________Father’s cell phone:_____________________________

Mother’s work phone:_______________________Father’s work phone:____________________________

Emergency contact person:________________________________________________________________

Emergency contact phone number:______________________

Years that student has taken ballet classes:________________

Please list any other information that we may need below, particularly physical or developmental limitations.

_________________________________________________________________________________________

Participant or parent/guardian signature_______________________Date:___________________________

FOR OFFICE USE:       CLASS LEVEL: ________________________ TUITION RATE: ____________________

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