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The Willis Ballet

Registration Form      

Studio Manager _________ Invoiced  __________

 

Student Registration Season ________________

Previous Students Please Indicate if Your Contact Information has Changed  Yes (    )  No (    )

Text Box: Date joined WCCB $35 Registration Total Weeks Discount Pd In Full Class Contract Coupon Office use only

 Student Information

 

Name (student):

_______________________________________________

Parent or Guardian Name:

_______________________________________________

Home Address:

_______________________________________________

 

 

Home phone:

_______________________________________________

Alternate phone :

_______________________________________________

Email address:

_______________________________________________

Students age and Birthday

_______________________________________________

Any medical problems?  Medications Used.

_______________________________________________

If yes, please explain:

_______________________________________________

Dance Class Name

_______________________________________________

Day/Time

_______________________________________________

Past dance experience:

_______________________Year joined WCCB ________

Costume Information

Height____________Waist_____________Girth________

Shoulder to Shoulder (front) ____    (Back)

Shoe Size______

 

Please Make Checks Payable to Willis Conservatory of Classical Ballet: 

 

I acknowledge that I have read and agree with the Willis Conservatory of Classical Ballet Waiver Form (see below).                          Signature required for class participation.

 

 

 

Thank you for Choosing Willis Conservatory of Classical Ballet for your Dance Lessons! Help us best serve the community by telling us how you heard about us.

 

Magazine/Publication Name_______________Yellow Pages _________  City of PC_________ 

Internet _________ Friend Referral ________________ Specify Other ___________

 

 

Waiver Release Form

I understand and agree to the following:

 

1.                    Tuition for the Willis Conservatory of Classical Ballet (CCB) is due at the beginning of each semester.  Payment is to be made to The Willis Conservatory of Classical Ballet and can be made in one or ten payments.

2.                    The Registration fee is non-transferable and non-refundable.  The annual registration fee of $35.00 is required for all students.

3.                    No refunds will be issued for missed lessons.  Make-ups are available for illness, injury, and or inclement weather during other class times to be approved by the CCB Director or Manager.

4.                    Refund policy:  CCB must receive in writing, a request stating the reason for a refund at least thirty days prior to withdrawal from the program and will be granted at the discretion of the Director.

5.                    I agree_______, I do not agree ______  to have my child’s photo and name to be posted on the Willis Ballet’s website.  If needed, I will ______, or will not  ______  provide the photo.

6.                    RELEASE:  The undersigned students, parent(s), or guardian of the student hereby release and waive any all claims against The Peggy Willis Ballet Company (The Willis Ballet) or The Willis Conservatory of Classical Ballet (CCB), its owners, director, manager, teachers, and or teaching assistants for any liabilities for injuries, including personal and bodily injury, to the person or persons related to students or the damage of property of the property of the person or persons related to the student, which may occur while participating at The Willis Ballet/CCB premises or at any premise building in conjunction with an activity by The Willis Ballet, unless said injuries or damage is caused by negligence of The Willis Ballet/CCB or any of its employees.  The undersigned represents that the student is in good health and does not have any history of a medical or physical condition (unless specified in the registration form) that would place the student at risk because of his/her condition.  The undersigned further acknowledges that the student’s instruction involves physical exercise and physical stress, which could result in physical injury of the student,

 

 

I agree to the Payment Play of ________ 1 payment ________ 10  payments

I acknowledge that I have read and completed the enrollment form and agree with the Waiver form above. 

 

(Parent or Guardian signature is required for Class Participation, unless student is over 18 years of age.)

 

 

Singed (parent or guardian’s signature if student is under 18 years of age)                      Date (      /      /       )

 

  

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