Principal Ballet Training - Online Registration

Online Registration / Contract Form

Before completing the entire form please make sure you are accepted into the program.
All fields are mandatory. Pay close attention to data you enter into the registration form and double check it before submitting. Registration without payment is not valid.
Note for new students! No beginners are accepted

Student's First Name*
Student's Last name*
Full Age
Date of Birth*
Check Full Age Entered Above!!!
Please Check What Apply To You
Choose The Program
You Will Learn*
Years of Dance (if any)*
Previous School/Instructor (if any)*
Type of Dance (if any)*
Student's Home Address*
City*
Zip Code*
Parent's Email*
Cell Phone*

Parent/Guardian's Name*
Person Responsible For Payments*
In Case of Emergency Please Notify
Phone*
Name*
Relationship*
Any medical or physical impairment's we may need to know about?*
Do you authorize your child to receive medical care?
Doctor's Name*
Doctor's Phone*
Hospital*
Referral Name*
Other (if any)*
Mailing list signup: Check this box to receive updates

I do not hold Principal Ballet Training responsible for any injury that may occur while my child is participating in or enrolled in classes at Principal Ballet Training.I'm registering my child in classes at the program at my own discretion I have read and understood all the information above and take full responsibility for reporting relevant information about tuition and my child's attendance
I read and agree with PBT Rules
I read and agree with PBT Policy & Procedure
Date of Registration (without payment is not valid)*
Cancelled if not paid in 3 business days
Date you will pay for Registration ($200 once a year)*
Contact us for acceptable Payment Options
You Will Pay Tuition For
I understand that All Payments are Non-Refundable
Please help us with our marketing.How did you hear about us?
This form is filled out and signed by (Full Name & Surname)*
Your Comments*
Please double check your application before sending
Do not enter anything in this field:

* indicates a required field

By submitting this form you agree to all terms and our program. All payments are non-refundable. Your Name and Surname act as Your Empowered Electronic Signature. Yes, I agree to follow the rules and want to register my child for Principal Ballet Training Program.

Please fill this field.