Howard County Ballet

2013-2014 Registration Form

(Please Print Clearly)
Name Age DOB
Parent (if minor)
Address
City, State Zip
Home Phone Work/Cell
Email Address
Circle one: youth adult professional (please fill out affiliation form)
Please list all classes you will be taking. Please list technique classes first, followed
by pointe classes.

Class and Level Day Time










Payment Schedule (select one)
Youth Payment in Full
Youth Installment Plan (due Sept 3, Nov 15, Feb 1, April 15)
Class card (dancers ages 18+only)
I hereby understand and agree that all classes shall be undertaken by me at my sole risk and
that Howard County Ballet Inc., shall not be responsible for any loss, property damage, or
personal injury arising out of or connected with my use of the facilities, or participation in the
classes or programs. I understand that the tuition installments are due by the specified
dates, and that a late fee will be added if payment is delinquent. Make-up classes are the
responsibility of the student; therefore rates will not bepro-rated due to missed classes.
Tuition paid is non-refundable. Written notification of withdrawal fromany class is
required 2 weeks prior to the withdrawal date.


Registrants Signature or Parent Signature (if under 21) Date
Howard County Ballet
2013-2014 Registration Form
(Please Print Clearly)
Name Age DOB
Parent (if minor)
Address
City, State Zip
Home Phone Work/Cell
Email Address
Circle one: youth adult professional (please fill out affiliation form)
Please list all classes you will be taking. Please list technique classes first, followed
by pointe classes.

Class and Level Day Time










Payment Schedule (select one)
Youth Payment in Full
Youth Installment Plan (due Sept 3, Nov 15, Feb 1, April 15)
Class card (dancers ages 18+only)
I hereby understand and agree that all classes shall be undertaken by me at my sole risk and
that Howard County Ballet Inc., shall not be responsible for any loss, property damage, or
personal injury arising out of or connected with my use of the facilities, or participation in the
classes or programs. I understand that the tuition installments are due by the specified
dates, and that a late fee will be added if payment is delinquent. Make-up classes are the
responsibility of the student; therefore rates will not bepro-rated due to missed classes.
Tuition paid is non-refundable. Written notification of withdrawal fromany class is
required 2 weeks prior to the withdrawal date.


Registrants Signature or Parent Signature (if under 21) Date