Decatur School of Ballet Online Registration

Registration

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Welcome to Decatur School of Ballet! Please complete the following registration form.

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info
(Not Parents)

Occupation

Contact #1

Parent #1 First Name*

Last Name *

Type

How Can We Contact You?

Home Phone *

Work #

Cell #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Parent #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Skill Notes

Started at DSOB what year?

Extracurricular activities

Family members at DSOB

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Skill Notes

Started at DSOB what year?

Extracurricular activities

Family members at DSOB

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Skill Notes

Started at DSOB what year?

Extracurricular activities

Family members at DSOB

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Skill Notes

Started at DSOB what year?

Extracurricular activities

Family members at DSOB

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunization Notes

Skill Notes

Started at DSOB what year?

Extracurricular activities

Family members at DSOB

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Agreement of Policy

I have included a $50 registration fee with this registration form

I understand that I am registering for the nine-month season, September 2019 through May 2020. I understand that, if I must withdraw after the school year begins and prior to December 31, 2019 the advance tuition for May 2020 is refundable when a month's written notice is given. I also understand that, after January 1, 2020 the advance tuition for May 2020 is not refundable.

I understand that my costume/performance fee ($100 for theater performers; $65 for studio demonstration performers) is due by October 9, 2019.

I agree to abide by the policies of Decatur School of Ballet.

I've read the above and agree.

Photo Release

I agree to allow my student to be photographed or videotaped. I understand that no release of personal information such as name or address will be made. I release Decatur School of Ballet from any damages in using photographs or video images of my child.

I've read the above and agree.

Release of Liability

Dance is a physical activity. With any physical activity comes the risk of injury. I release Decatur School of Ballet of any liability associated with accidental injury.

I've read the above and agree.

Medical Emergencies

In the event of injury or illness, if Decatur School of Ballet cannot contact a family member, I give permission to have emergency services called to transport my dancer to the closest medical facility.

I've read the above and agree.

Payment Policy Agreement

I understand my payment plan and will make timely payments.

I understand that I am responsible for any fees associated with payments which cannot be processed due to insufficient funds.

I give permission to Decatur School of Ballet to process credit cards or debits to my bank account(s). I also agree to renew this permission annually.

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*