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Student Information

First name *

Last name *

Student Date of Birth *

Student Age *

Street Address *

City *

State *

Zip code *

Summer Class

Level *

1-2 (Tues/Thurs 6:00-7:00 pm)

3-4 (Tues 5:00-7:00 pm/Thurs 4:30-6:00 pm)

4-8 (Mon 4:30-6:00 pm)

5-8 (Tues 4:30-6:00 pm/Thurs 5:00-7:00 pm)

Number of classes

1/wk

2/wk

3/wk

*Parent/Guardian Information

1) Parent/Guardian Name *

Cellphone Number *

Email Address *

Workplace (this helps Ballet Minnesota with funding requests)

2) Parent/Guardian Name

Cellphone Number

Email Address

Workplace (this helps Ballet Minnesota with funding requests)

Other Information

Academic School

Phone Number

Local Newspaper

Section

Agreement to expectations and terms

Financial:
Registration/Tuition Fee are due in full at registration. A student is not considered registered until a payment for the full costs are received at CBA.

Other:

1. Please inform staff of any medical conditions which might affect class participation.

2. The parent or guardian agree that in case of medical emergency, after every reasonable effort has been made to contact them, to have the physician secured by the adult in charge of activities to hospitalize, secure treatment for and to order injection, anesthesia or surgery for the child. In the event any such treatment is not covered by insurance applicable to the activities, the parent / guardian will pay the expenses incurred in such emergency treatment.

3. Classical Ballet Academy, employees and/or guests shall not be held responsible for injury or illness to a student while student is attending classes or performing with CBA or Ballet Minnesota.

4. By signing below you agree that any photos taken by CBA or Ballet Minnesota of a CBA student, while enrolled in CBA (during class, rehearsal or performance), may be used by CBA or Ballet Minnesota for advertising, promotion, and/or publication purposes.

Signature *

Clear

Parent / Guardian: I acknowledge that I have read the above rules and by signing here I agree to the conditions of these CBA rules & regulations as stated above. ( Form must be signed in order to be registered at CBA)

CBA Parents Contact List sign-up

Consent to sign up for CBA parents email and contact list--IMPORTANT for receiving communications about your student(s) class schedule, rehearsal schedule, performances, etc. *

Yes

No. Reason:No. Reason:

Please only opt out of this option in special circumstances, and provide a reason in the text box so we can work with you to set up an alternate method of communication about your student.

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