Student's Name: ______________________________________________________________________Date________
Age______ Birth date:_____________________________School____________________________________________
Parent: __________________________________________________________________________________________
Home Address: ___________________________________________________________________________________
Contact Phone number (during class hours):____________________________________________________________
Phone (home) ___________________________Phone (wk/cell) ____________________________________________
E-mail:________________________________________
List each class on a separate line circle the class length
Class(es) desired: 1.______________________________________________Day__________time__________ 45mins 1hr 1.25
2. _____________________________________________________________Day__________time_________ 45mins 1hr 1.25
3. _____________________________________________________________Day__________time__________ 45mins 1hr 1.25
4. _____________________________________________________________Day__________time__________ 45mins 1hr 1.25
| Please print and return on first day of classes The Ballet Studio Winter/Spring 2010 Registration Form Preregistration is required for all classes January 4-June 12 |
The Ballet Studio
Ballet, Jazz and Tap Dance classes for children & adults
Email: TheBalletStudio@DelrayDance.com
703-379-1649
2107 Mt. Vernon Ave. Alexandria, Va 22301
Ballet, Jazz and Tap Dance classes for children & adults
Email: TheBalletStudio@DelrayDance.com
703-379-1649
2107 Mt. Vernon Ave. Alexandria, Va 22301
 | |  | |  | |  | |  | |  | |  |
Dance is a physical exercise. As the parent of the above named child, I understand that. By signing or making and
staff are not liable for costs due to injury.
Parent's Signature ___________________________Date:_______________________
staff are not liable for costs due to injury.
Parent's Signature ___________________________Date:_______________________
Registration Form |
| [ ] 1hr 15min. class $375.00 [ ] 1 hr class plus One 45 min class - $575.00 [ ] Two 45 minute classes - $515.00 [ ] Two 1 hr $615.00 [ ] 1 hr class plus One 1hr 15min. class - $640.00 [ ] Two 1 hr 15min. classes/wk - $650.00 *The Ballet Studio allows payment arrangements upon request. New this semester are a limited number of work/study positions. In addition, for the W/S2010 semester there are a limited number of full and partial scholarships offered by The Ballet Studio for qualifying applicants. Contact the Studio Director for more information. Total Tuition due (attached) _________________________________ * 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:_________________________________________________ The Ballet Studio 2107 Mt. Vernon Ave. Alexandria Virginia 22301 www.DelrayDance.com 703-379-1649 WS2010 |
Studio.
[ ] No, I would not like 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
| To the Pointe classes: [ ] Ballet Ia & Ballet Ib - $640.00 |
| Teen Pre Professional Ballet, Jazz, Tap (or any 3 classes per week) |