* Student Name
* Mailing Address
Student Date of Birth
* Student Date of Birth
Name(s) of Parent/Guardian
Cell Phone Parent 1
* Cell Phone Parent 1
Cell Phone Parent 2
* Cell Phone Parent 2
If you are new to FSBT, how did you hear about our program?*
Has the student had any serious physical injuries? If yes, please explain.
Does the student have any mental, emotional or physical conditions that might affect or impair his or her ability to participate in dance training? If yes, please explain.
Does your student have any allergies? if yes, please list.
Insurance Company (not necessary for adult students)
Policy Number (not necessary for adult students)
Group Number (not necessary for adult students)
FSBT School Registration Terms and Conditions
In signing this registration form for myself or on behalf of a minor student, I have read and understand the payment schedule set forth. I understand that all there are no refunds or deductions for missed classes.
I agree that my minor student or that I myself will abide by the polices of The School of First State Ballet Theatre. I consent to my minor student or myself participating in the school’s programs and activities. I recognize that in spite of the care of the school and its teachers that there is a possibility of injury during classes. In the case of such an injury to myself or my minor student, I release The School of First State Ballet Theatre, its teachers and associated personnel from all responsibility.
In the event of an injury to myself or my minor student which requires emergency medical attention, I permit the school to obtain such care and I promise to pay all associated costs upon receipt of the bill. I understand that The School of First State Ballet Theatre is not responsible for any student outside of the studio.
I hereby authorize The School of First State Ballet Theatre the use all photographs and video of my minor student or myself for publicity including advertising and sales promotion.
I have read, understand and agree to the policies of The School of First State Ballet Theatre, Payment Conditions, Liability Release, Medical Release and the Publicity Release.
Thank you! Your payment will be due at the first class. We look forward to seeing you!