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Pre-Registration Form Year 2017-2018

* Indicates required field

Student's Name *

First

Last

Age *

Date of Birth *

Home Phone Number *

Years of training *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Preferred Email *

Academic & Previous Dance School *

How did you hear about us? *

Parent's Name *

Phone Number *

Emergency Contact *

Phone Number *

Physician's Name *

Physician's Phone *

Student's Allergies *

Class/Level/Day(s) *

* By submitting this form, I acknowledge that I understand all payments are non-refundable and students must follow all school policies and regulations. I give permission to West Point Ballet, LLC to take photos of my daughter, or son, and use them to promote the school. I am aware that there is a certain degree of risk involved in all physical activity, and that potentially severe injuries can occur. I hereby waive, release, and hold harmless West Point Ballet, LLC, its director, employees, and staff from liability, or claim resulting from my child’s participation in all West Point Ballet, LLC classes, and activities. I authorize West Point Ballet, LLC to administer first-aid, and/or authorize medical treatment if necessary. I hereby grant authority to allow all emergency medical treatment necessary at any medical facility, and assume the responsibility for payment of this medical treatment.

*Guardian's Full Name *

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