County Ballet Student Registration
2232 Old Emmorton Road, Bel Air, MD 21015 -  (410)-515-0031 * (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:

How did you learn of County Ballet?



Which classes will you be taking?

What day(s)?

8 weeks or 16 weeks?





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.


TUITION MUST BE PAID IN FULL AT TIME OF REGISTRATION.
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.

Signature:



Date:







Dancers image may appear in ads?





If you agree, please initial here:





DO NOT USE dancers image on any advertising







Textbook is required if registering for Ballet level A/ B, Pre Pointe Ballet, Foundation.
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: Pjlauer2@gmail.com
to assure proper placement. Thank You
Fill out your registration form on line
and pay in the store.

Thank You!
Tuition/Registration
Notes
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 additional pappers write in / e-mail / bring in.

Search engineFlyerFriendFace BookProperty SignageOther