Registration Form 2011-2012
Registration Fee $35
Early Bird Registration before 5/12/2011: $25
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Registration Form 2011-2012
Registration Fee $35 Early Bird Registration before 5/12/2011: $25 |
To speed registration, print this page and mail or bring in your registration form with payment to the Columbus City Ballet School, 763 Radio Drive, Lewis Center, OH 43035, 614-841-9399 or 614-384-0222.
Student’s Name__________________________________________
Birth date_____/____/___ Age: _____ Grade in School_________
Parent’s Name_______________________________________________
Address___________________________________ State___________ Zip____________
Mother’s Occupation _____________________(Work phone)_______________(Cell)___________
Father’s Occupation _____________________(Work phone)_______________(Cell)___________
Home Phone____________________________________
E-mail __________________________________
In case of emergency please contact (if parent or guardian not available):
Name_____________________________ Phone_______________
Physician_________________________ Phone__________________
Name of previous dance school_______________________________
How many years of dance training?_______________________How did you hear about us?___________________________
Registration fee ________ Total ____________ Check # ____________ Date ______________
New Student ______ Returning Student __________
Visa/MC/Am Exp_________________________________________
Children’s Division |
Progressive Division (2-8 classes/week) |
| Little Ballerinas ____ | Ballet 2A___ Ballet 4A____ Ballet 7 ____ |
| Broadway Little Dancers ___ | Beginning Pointe_____ |
| Little Gymnastics/Ballet (ages 4-6)____ | Pointe_____ |
| Pre Ballet ____ | Variation____ |
| Primary Ballet ___ | Repertoire ____ |
| Primary Ballet/Tap____ | Contemporary ____ |
| Primary Ballet/Gymnastics (ages 5-7) | High Int. Ballet ____ |
| Advanced Ballet____ | |
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| Ballet 1, 2, 3 _____ | Adv. Jazz ___ |
| Boys’ Class____ | Modern_____ |
| Jazz 2, 3 ____ | Contemporary ____ |
| Adult Ballet/Stretch____ | Pilates Matwork____ |
Student Professional Mentoring Program (10-12 classes/week) |
Pre-Trainee Ballet Program |
| PMP 5 ____ PMP 1 ____ | by invitation only ____ |
Waiver of Liability/Agreement to Pay/Media Release
The below signed hereby hold harmless Columbus City Ballet School or any agents thereof for any illness or injury due to participation in any class, rehearsals and performance, or other activity associated with Columbus City Ballet School. I hereby certify that I agree to the CCBS Policies and Regulations. In addition, I give permission for photographs or television footage that may include my child for any media publication concerning CCBS.
Signature:______________________ Parent:______________________ Date_________