Ballet Conservatory of South Texas Online Registration

Registration

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Welcome to The Ballet Conservatory of South Texas! Thank you for choosing us for your dance education. To register, you must fill in all of the required information. There is an annual $50 registration per family. You may indicate your class/day preferences in the comments section below. Students age eight and up with previous ballet experience will be evaluated to determine level placement. Questions? Please call the office at 210-820-3400 or email FrontDesk@balletconservatory.org

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Student's Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info (please include NAME and PHONE NUMBER for someone other than legal guardian)*

Health Insurance Carrier*

Contact #1

Contact #1 First Name*

Last Name *

Type

How Can We Contact You?

Home Phone

Work #

Cell # *

Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Receive Text Message Notifications

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Cell #

Receive Text Message Notifications

Additional Info

Student Email

Please list any physical/psychological/emotional contitions or injuries that may affect the student.*

Please list any allergies. If the allergy is life threating please list any medical directives.*

If the student carries medication with them please list them here.*

Primary Doctor

Are immunizations up to date?*

Please list any previous ballet training.*

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Cell #

Receive Text Message Notifications

Additional Info

Student Email

Please list any physical/psychological/emotional contitions or injuries that may affect the student.*

Please list any allergies. If the allergy is life threating please list any medical directives.*

If the student carries medication with them please list them here.*

Primary Doctor

Are immunizations up to date?*

Please list any previous ballet training.*

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Cell #

Receive Text Message Notifications

Additional Info

Student Email

Please list any physical/psychological/emotional contitions or injuries that may affect the student.*

Please list any allergies. If the allergy is life threating please list any medical directives.*

If the student carries medication with them please list them here.*

Primary Doctor

Are immunizations up to date?*

Please list any previous ballet training.*

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Cell #

Receive Text Message Notifications

Additional Info

Student Email

Please list any physical/psychological/emotional contitions or injuries that may affect the student.*

Please list any allergies. If the allergy is life threating please list any medical directives.*

If the student carries medication with them please list them here.*

Primary Doctor

Are immunizations up to date?*

Please list any previous ballet training.*

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Cell #

Receive Text Message Notifications

Additional Info

Student Email

Please list any physical/psychological/emotional contitions or injuries that may affect the student.*

Please list any allergies. If the allergy is life threating please list any medical directives.*

If the student carries medication with them please list them here.*

Primary Doctor

Are immunizations up to date?*

Please list any previous ballet training.*

Add Another Student

Required Policies and Agreements

Participation Release

In consideration of the benefits of instructions provided by the Ballet Conservatory of South Texas, I/we, intending to be legally bound, do hereby apply for enrollment for the afore named student. I/we accept the risks of motion exploration activities, and do hereby waive claim and release the Ballet Conservatory of South Texas, and/or its staff, instructors, and other personnel (hereinafter referred to individually or jointly as the Conservatory) for claim or liability for any injury or accident occurring or arising from the instructional program or sponsored incidental activities, either on or off premises.

I've read the above and agree.

Text Message

I/we understand that I/we must agree to receive text notifications from the Conservatory in order for my dancer to participate in the instructional program or sponsored incidental activities with the Conservatory.

I've read the above and agree.

Permission for Medical Treatment

I/we authorize emergency first aid care to be administered to afore named student by the Conservatory in the event they become injured or ill during instructional program or sponsored incidental activities either on or off premises. If the parent(s) or guardian(s) of the student are not immediately available at the telephone numbers provided on this enrollment application, I/we further authorize the Conservatory, or such agents to retain the services of a doctor or other competent medical personnel in order to treat the student.

I've read the above and agree.

Verification of Participation Ability

I/we do warrant the Conservatory that the child herewith enrolled is physically, psychologically, and emotionally capable of motion exploration activities and is only limited by the conditions noted on this enrollment form. The Conservatory urges that a complete physical examination be undertaken for the student before beginning these activities.

I've read the above and agree.

Media Release

I/we do give the Conservatory permission to display or publish photos/videos of the afore mentioned student on the Conservatory website and/or the Conservatory social media sites for the purpose of outreach and marketing.

I've read the above and agree.

Tuition Policies

I/we have read and agree to the tuition policy requirements for the Conservatory.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*