County Ballet Student Registration 
2232 Old Emmorton Road, Bel Air, MD 21015 -  (410)-515-0031 or (410)-569-0316

Student’s Name: 

Date of Birth:                                                          Present Age: 

Parent/Guardian’s Name:

Street Address: 

City:                                                                       ZIP: 

Telephone:(H)                                                                                (C)

E-Mail Address: 

ADULT STUDENTS- Name and Phone # of Emergency Contact 

How did you learn of County Ballet?

Which classes will you be taking?

What day(s)?

Additional people allowed to pick up dancer? NAME, Relation to Dancer, Phone #

There is a $35.00 Registration fee per family /per year.

Liability Agreement: I agree that I will not hold a faculty member or an employee
 of County Ballet, liable for injuries sustained or for illnesses contracted by me/my child
 while a student/participant at County Ballet. I agree to indemnify County Ballet and its faculty
 for all liabilities, costs, and judgments arising for acts of omissions of the undersigned,
 which result in injury or damage to any person or party. I further agree that I will not hold 
County Ballet or any faculty member responsible for the loss or damage 
of personal property during participation.

Checks, Cash and Credit Cards accepted.  There are no transfers, credits, or cash refunds for classes unless medical certification is presented. 

Uniform Agreement: All students should have the required uniform within two weeks of starting classes and maintain a proper uniform throughout the semester.
I have read and understand the refund policy, uniform agreement and waive all claims of liability.



Dancers image may appear in group photos or ads (no tagging)- YES or NO?

If you agree, please initial here:

I will phone in with credit card,  mail in a check,  or stop in and visit The Dance Shop.    (Pick one)

2232 Old Emmorton Road Bel Air, MD 21015
410-515-0031 * 410-569-0316

Registering on line? 
Please contact the instructor:
to assure proper placement. Thank You

Fill out your registration form online. 
Tuition and  Registration fee may be paid by: Pay Pal, 
pay in The Dance Shop, phone in your charge or mail a check.

Thank You!
Please List previous dance training or any medical problems the instructor should be aware of - Developmental level, allergies, or anything which will help our instructors give your dancer the best possible education.
Attach any supporting pappers write in / e-mail / bring in.

All classes require registration. Classes with less than 5 dancers will be canceled. Classes limited to 8 dancers.
Payment is accepted in cash, credit card, or check made payable to County Ballet.
Family discounts of 10% off additional family members first class / lesser tuition.
Military discount of 10% all family members, not combined with other discounts.
There are no transfers, credits, or refunds. Partial Tuition extensions only with Pandemic Medical health situations.

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