Registration Form - Northeast Youth Ballet

Northeast School of Ballet Studios

Student
First Name Last Name Birthday Age
Address*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian
Name Home phone Cell Phone Emergency Contact Emergency Phone Allergies/Medical Condition
Email*
I am interested in:
- Basic Creative Movement
- Pre-Ballet
- Pointe
- Ballet
- Modern
- Boys Class
- Jazz
- Tap
- Ballroom
I hereby enroll (NAME)
in NSB, Inc Dance Program. I understand that after the program has begun on Monday, September 11, 2017 should the student for whatever reason be unable to attend, withdraw, be dismissed for cause or be absent from the program, tuition will not be refunded. I am aware that ballet training and the exercise associated with it can place stresses on the body and can risk physical injury. I assume the risk and agree that NSB, Inc will not be liable in any way for injuries sustained during attendance at the school and related functions.
Authorize*
Signature Date
Phone
This field is for validation purposes and should be left unchanged.