EmailMe Form - ABA New Student Registration Form

Student Information

Please fill out the fields below as they relate to the student.

Student Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Student's Email

Student's Cell Phone

### - ### - ####

Student's Home Phone

### - ### - ####

Student's Date of Birth *

MM / DD / YYYY

Age *

Gender *

Boy

Girl

Other

Ethnicity *

Academic School *

Grade *

Does the student have any medical concerns of which we should be aware? *

Dance Information

What class level was the student assigned in their audition/placement class? *

How many classes a week will the student be taking? *

Please list the days & times of the classes the student will be enrolled in. *

Previous dance training *

Emergency Information

Emergency Contact Name *

First Last

Relationship to Student *

Phone *

### - ### - ####

Billing Contact 1

Name *

First Last

Relationship to Student *

Email *

Cell Phone *

### - ### - ####

Work Phone

### - ### - ####

Occupation *

Is your address the same as the student's? *

Yes

No

If so, it is not necessary to fill out the address section below.

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Billing Contact 2

Name

First Last

Relationship to Student

Email

Cell Phone

### - ### - ####

Work Phone

### - ### - ####

Occupation

Is your address the same as the student's?

Yes

No

If so, it is not necessary to fill out the address section below.

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

To register as a new student at the Academy of Ballet Arts you must pay the $15 New Student Registration Fee.

Please know that this form will automatically redirect you to PayPal once you have clicked "Submit." If you would prefer to use a different payment method, simply close the PayPal window and submit your payment elsewhere. Please make checks payable to: The Academy of Ballet Arts, Inc. and enter your check number in the box provided for you.

What is your preferred payment method? *

PayPal

Venmo (@ABA-StPete)

Check

If paying with a check, please enter the check number above.

Do you agree to pay the $15 New Student Registration Fee? *

YES, I agree to pay the $15 fee

NO, I will not to pay the $15 fee

Other Information

Do you have another child in attendance at The Academy of Ballet Arts, Inc.? *

Yes

No

If yes, please list the name(s) below

Student Name
Student Name
Student Name

How did you hear about The Academy of Ballet Arts, Inc.? *

Please read and sign below.

I/We understand that tuition is payable on the first of each month. A late fee of $10.00 will be charged for payments made after the tenth of each month. Absences may be made up only during the month in which the classes were missed and only in the classes designated by the teacher.

No adjustments in monthly tuition will be made for missed classes due to illness, work schedules, vacations or holidays.

By your signature below, you acknowledge that photographs and/or video may be taken of the student, and that The Academy of Ballet Arts, Inc. may use such media and/or likenesses in print, on the Internet, and/or for training purposes. If you have an objection to the use of your student’s image, please contact The Academy of Ballet Arts, Inc. before completing this form.

The Academy of Ballet Arts, Inc. does not discriminate on the basis of race, color, gender, marital status, age, sexual orientation, disability, religious preference and national or ethnic origin.

Signature: please print your full name. *

Date Time *

MM / DD / YYYY

At the completion of this form, you will automatically be redirected to PayPal. However, if you wish to pay by check or Venmo (@ABA-StPete), enter your check number in the box above and then simply close the PayPal window. Please note that your order will not be completed until a check or Venmo payment is received. Make all checks payable to the Academy of Ballet Arts, Inc.

**** Please only click the "Submit" button once to help avoid duplicate orders.
Note: sometimes it may take a couple of moments for the form to process and redirect to PayPal.