Marblehead School of Ballet registration form
Name:	________________________________________________________
Parent/Guardian:	________________________________________________________
Address	________________________________________________________
City, State, ZIP:	________________________________________________________
Date of Birth:	________________________________________________________
Telephone:	Home: _________________________ Work: __________________
Email Address:	________________________________________________________
Previous dance experience (where/how long?)
How did you hear about the Marblehead School of Ballet?

Class	Class enrollment date	Time	Cost
Tuition:

Waiver of Liability:

I agree that I will not hold the Marblehead School of Ballet, the North Shore Civic Ballet, or any faculty member or employee of either liable for injuries sustained or illness contracted by me while a student participating in the activities above.
I agree to abide by the rules and regulations of the Marblehead School of Ballet. I have read the above policy statements and waiver of liability and hereby agree to comply with them.

________________________________________	_______________________________________
Applicants Signature (if 18 years or older)	Parent or Guardian (if applicant is less than 18 years of age)