2009 Summer Registration Form
Please fill out a separate form for each student.

*Required Fields.

*Parent's Email Address
*Student’s Name
*Address
*City
*State
*Zip
*Home Phone	- -
Cell Phone
Student’s Email Address
*Grade (09-10)
*Birth Date (not 2009)	/ /
Academic school student attends
*Mother/Guardians' name
Father/Guardians' name
Physician’s Name
Physician's Phone #
Father’s employer
Father's Work #
Mother’s employer
Mother's Work #
*How did you hear about us: check one or more:
Television ad	Radio ad
Yellow pages	Web Site
Word of Mouth	Mailing
*REGISTERING FOR (check one or more):
Jump Start
Dance Camp
Advanced Ballet
Adult Ballet	Tap
Jazz	Hip-Hop
Turns and Leaps	Stretching and Toning
special requests
Submitting this form means that you accept the following: "I hereby enroll myself or my child for the entire term and agree to follow all payment policies, dress code, and other rules and regulations as stated in this web site. I understand that all tuition payments are nonrefundable and agree to pay the late fees for late tuition payments and the service charge for bad checks. I recognize that attendance and participation may expose me or my child to risk of injury and harm. I accept this risk and agree that Greenville Ballet School and its staff will not be held responsible should such injury or harm occur. I hereby authorize the Greenville Ballet School to use photographs of the student on its website and in any publicity materials. "

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