Registration Form 2008-2009
Early Fall Registration Fee $25
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Registration Form 2008-2009
Early Fall Registration Fee $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.
Student’s Name__________________________________________
Birth date_____/____/___ Age: _____ Grade in School_________
Parent's Name_______________________________________________
Address___________________________________ (State)___________ (Zip)____________
Mother’s Occupation _____________________(W)_______________(C)___________
Father’s Occupation _____________________(W)_______________(C)___________
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_________________________________________
Early Childhood Division |
Progressive Division |
| Creative Movement (age 3) ____ | Ballet 1A___ 2A____ 3A____ 4A____ 5A____ |
| Pre Ballet (age 4) ___ | 7A ____ |
| Pre Ballet/Tap (ages 4-5) ___ | Pointe_____ Variation____ Modern____ |
| Primary Ballet (ages 5-6) ____ | Beg. Pointe___ Int. Pointe___ |
| Primary Ballet/Tap____ | Jazz ___ |
| Acro/dance (ages 5-6) ____ | |
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| Ballet 1, 2, 3 _____ | Ballet 1B, 2B _____ |
| Adv. Ballet____ | Modern_____ |
| Boys' Class____ | Preteen Beg. Ballet (ages 9-12) ___ |
| Int. Tap ____ Tap 1, 2 ____ (ages 7-11) | (ages 70-11Adv. Tap____ |
| Adult Ballet/Stretch____ | Pilates Matwork____ |
Yoga ____ |
Int. Jazz ___ |
| Adv. Jazz ___ | |
| Preprofessional Mentoring Program |
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| PMP 1 ____ PMP 2 ____ PMP 3 ____ | How many classes/hours per week do you take? ____ |
| Ballet Technique, Pointe, Variations, Repertory, Modern, Jazz, Pilates Matwork/Stretch, Production, Classical Music Appreciation, Workshop, Adagio | |
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_________