Columbia County Ballet Registration Form

Please Note: Class sizes are limited. Registrations are accepted in the order they are received.

PARENT'S INFORMATION
Father's Name		Work Phone
Occupation

Mother's Name		Work Phone
Occupation

Home Address		City, State Zip
Home Phone		Cell Phone
Email Contact

How did you find us?

STUDENT(S) INFORMATION

Student's Name		School
Age		Birthday
Class's Choice(s)		View Class Schedule
1st Choice Schedule
Day(s)		Time(s)
2nd Choice Schedule
Day(s)		Time(s)
* * * * * * * * * * * * * * * * * * * *
Student's Name		School
Age		Birthday
Class's Choice(s)
1st Choice Schedule
Day(s)		Time(s)
2nd Choice Schedule
Day(s)		Time(s)
* * * * * * * * * * * * * * * * * * * * *
Student's Name		School
Age		Birthday
Class's Choice(s)
1st Choice Schedule
Day(s)		Time(s)
2nd Choice Schedule
Day(s)		Time(s)

Classes are limited to 12 students per class.(Does not apply to company dancers).

Please Read the following Agreement::
I understand that tuition and fees are non-refundable. Tuition is debited the 5th of each month. I hereby give permission to the Columbia County Ballet to use any photo that includes my child taken in dance for promotional purposes. I will not hold the Columbia County Ballet or it's staff (either paid or volunteer) responsible for injuries sustained by my child while participating in class or other activities at or concerning the Columbia County Ballet. If I am not available in the event my child needs medical attention, I hereby give permission to the staff of the Columbia County Ballet, or to any competent medical authority, to render any necessary medical attention to my child. The Columbia County Ballet is not responsible for any activities, altercations, or automobile accidents that occur either on the premises or while entering or exiting the property on which the Columbia County Ballet is located. I have read and understand Academy policies.

I will be using Auto-Pay for tuition.

YES NO