Registration Form

August 2016-June 2017

1420 N Fox Crossing
Elk Ridge, Ut 84651
(801) 361- 5073
NeboBallet.com
Parent/Guardian Name______________________________________________________________
Street Address_________________________________________City____________Zip____________
Email Address________________________________
Phone Number________________________________

Can you receive text messages? Y/N

How did you hear about us?____________________________________________________________

Please list previous dance experience (new students only)_____________________________________
Student Name_______________________________________Age_______Birthday_______________
Classes registering for: (Circle all that apply)
Pre-Ballet 1
Pre-Ballet 2
Level 1
Student #2 Name_____________________________________Age_______Birthday______________
Classes registering for: (Circle all that apply)
Pre-Ballet 1
Pre-Ballet 2
Level 1
Student #3 Name_____________________________________Age_______Birthday______________
Classes registering for: (Circle all that apply)
Pre-Ballet 1
Pre-Ballet 2
Level 1

I have enclosed with this form my registration fee: $20 for new students $15 for Returning students.
I have read, understand, and agree to all terms in the studio policy handbook. I understand that failure
to adhere to studio policies will result in removal of classes or loss of performance privileges.
DISCLAIMER/RELEASE
I hereby release Nebo Ballet from any and all claims for damages or injuries which a person might
sustain while participating in any activity connected with our studio on or off our premises. I give
Nebo Ballet Academy my permission to use videos and photographs of my child for advertising and/or
publication purposes whether print, or electronic publishing via the internet.
Parent/Guardian Signature_________________________________________Date_________________