Balletomane - Summer Session Registration Form

Student's Name*

First Last

Parent/Guardian Name

First Last

Address*

Street Address Address Line 2 City Province Postal Code

Home Phone*

Phone

Email

Student's Birth Date*

MM

DD

YYYY

SESSION SELECTION & PAYMENT INFORMATION

VOCATIONAL INTENSIVE SUMMER SESSION

Ages (7 to 18+ Years) ** Note: Students will be placed in Session Groups based on Age / Dance Level

Last Ballet Examination / Level Completed

Last Modern Examination / Level Completed

NURSERY SUMMER SESSIONS (Ages 3 and 4)

PRIMARY SUMMER SESSIONS (Ages 5 to 7)

*

I authorize Balletomane Inc. to process the applicable fees to my credit card (information below). I will be contacted by Balletomane Inc. to confirm enrollment / fees before my credit card is charged.

Payment Type (Select One)*

Card Number

Expiry Date (MM/YY)

Name on Card

First Last

*

I hereby certify that my child is in good physical condition and is able to participate fully in the programme. I release Balletomane Inc. and its Artistic Faculty from liability in case of accident or injury. I understand that classes will be conducted in the safest possible manner by trained, professional faculty.