New student Registration form

(Please fill out this for form and we will contact you back with more information)

Student Name*

First Name

Last Name

Date of birth (MM/DD/YYYY)*

Student Age*

Parent name*

Phone number*

(###)

###

####

Email Address*

Home Address*

Address 1

Address 2

City*

State/Province*

Zip/Postal Code*

Country*

Indicate any illnesses or allergies or other concerns we should know about: (i.e. asthma) * * It is very crucial that we know your kid well. If not any, just type in "NO" above.

We inquire about illnesses and allergies so we can take every precaution possible with your child’s health. Although dancing is not considered dangerous, there is always a chance of an accident occurring and we want to take every precaution to protect you and your child. If an accident does occur during a supervised activity, I understand that the instructors of Columbia Youth Ballet is not responsible. I understand that I am signing up for the complete yearly program. Registration deposit and tuition are non-refundable. * Please initial below

Photo/video Release Term; I, guardian of the above named student(s), hereby consent to the participation for the student(s) in Columbia Youth Ballet programs. I hereby give permission to Columbia Youth Ballet to take photographs, film, or videos of my child or myself. I consent to the use of such materials and/or the use of my child’s name for promotional purposes by Columbia Youth Academy/CYB. *

I agree

Parent or Guardian Signature * Just type in your full name to e-sign.

Notes you want us to know

New student Registration form

Columbia Youth Ballet

The Studio

CULOMBIA YOUTH BALLET