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+1 (973) 625-4265

Register to Join EBA Today!

Student's Full Name*

Birthday*

Month

Day

Year

Gender*

Address*

Student's Email*

Student's Phone #*

Allergies/Medical Conditions*

Medications*

Previous Dance Schools Attended*

Years of Ballet Training*

Styles of Dance Studied*

Parent/Guardian #1 Full Name*

Parent/Guardian #1 Email*

Parent/Guardian #1 Phone*

Parent/Guardian #2 Full Name*

Parent/Guardian #2 Email*

Parent/Guardian #2 Phone*

Emergency Contact Full Name*

Relationship to Student*

Phone*

Email*

Preferred Class Days/Times (Check all available)*

Monday Evenings

Tuesday Evenings

Wednesday Evenings

Thursday Evenings

Friday Evenings

Saturday Mornings

Saturday Afternoons

Saturday Evenings

Sunday Mornings

Sunday Afternoons

No Preference

Other

Is your student interested in private classes?*

Yes

How did you hear about our ballet academy?*

Is there any other information you would like for us to know?*

Consent and Agreement:

• I hereby grant permission for my child/myself to participate in ballet classes at Etoile Ballet Academy.

• I understand and agree to the terms and conditions of the Etoile Ballet Academy

Signed Student Code of Conduct (See below to download blank form)*

Signed Parent Expectations (See below to download blank form)*

Signed Safety Waiver and Release Form (See below to download blank form)*

Signature*

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Code of Conduct

Parent Expectations

Waiver and Release

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