Student’s Name________________________________________________ age____________ Birth date _____________________________________school__________________________ Parent’s Name ________________________________________________________________ Address _____________________________________________________________________ Phone number during class hours_________________________________________________ Home phone__________________________ cell_____________________________________ Email________________________________________________________________________ Please check all Workshops you are registering for: [ ] Session I: Fairytale Ballets: Sleeping Beauty, Petruska, Cinderella July 13-17 9:30-12:30 ages 5-7 [ ] Session II: Broadway Musicals: The King & I, The Sound of Music August 3-7 9:30am-12:30pm ages 6-9 [ ] Session III: Big Screen Musicals- Fame, High School Musical, The Wizard of Oz August 10-14 9:30am-12:30pm ages 7-10 TUITION: Summer Workshops - $170.00 per session Two sessions - $300.00 Total tuition _______________ (attached) [ ] Yes, I allow my child’s picture to be used in promotional materials for The Ballet Studio. [ ] No, I would not like my child’s picture to be used in promotional materials for The Ballet Studio. Dance is a physical exercise. As the parent of the above named child, I understand that. By signing below and/or making payment for classes and workshops, I agree that the Ballet Studio owner(s) and staff are not responsible for injuries occurring by reason of participation in classes, workshops or other studio events. And, The Ballet Studio owner(s) and staff are not liable for costs due to injury. Parents Signature: ____________________________________Date:______________________________ |
| 2009 Summer Dance Arts Workshops at The Ballet Studio Registration Form Summer Workshops |
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- 703-379-1649 2107 Mt. Vernon Ave. Alexandria, Va 22301