EmailMe Form - ABA Adult Registration

Dancer's Information

Name *

First Last

Address *

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

Occupation

Email *

Cell Phone *

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

Home Phone

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

Date of Birth *

MM / DD / YYYY

Age *

Height *

Gender *

Boy

Girl

Other

Ethnicity *

Do you have any medical concerns of which we should be aware? *

Dance Background information

Current Dance Studio *

Please explain your dance training. *

Which Adult Classes are you Registering for?

Please list each of the adults classes you will be taking? *

Do you intend to pay for classes by the class or monthly? *

Pay by the class

Pay monthly

What is your preferred payment method? *

PayPal

Venmo

Check

Cash

Emergency Information

Emergency Contact Name *

First Last

Phone *

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

Other Information

How did you hear about this audition? *

I understand that by filling out and submitting this form I am committing to participating in the Adult Zoom Ballet Class and will pay the required tuition for this class.

Initial Here *

Please read and sign below.

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