ST. Lucia School of Ballet & Modern Dance

ENROLMENT FORM
Please Complete Form in BLOCK CAPITAL Letters
Registration Fee $50.00

Name: Male Female

Home Address: Telephone No. :

Date of Birth: Age on Last Birthday:

Postal/Mailing Address (essential):

E-mail:

Name of School Attending:

Names of Parents/Guardians: (name)

(Address) (home #)

(work #) (relationship to applicant)

(Name)

(Address) (home #)

(work #) (relationship to applicant)

Contact Person in Case of Emergency: (name)

(Address) (home #)

(work #) (relationship to applicant)

Sponsor of Fees for the Applicant: (name)

(Address) (home #)

(work #) (relationship to applicant)

How did you hear about us? Word of Mouth Radio Ad TV Ad Internet Promo Literature
Other

Has the Applicant had any previous Classical Ballet and/or Modern Dance Training?

Yes No

If “Yes”, please answer the following questions

Name & Address of Dancing School Attended:

Number of Years of Training: Grades Completed:

Allergies/Medical Conditions:

Additional Information:

Signed: Name (PRINT):

Relationship to Applicant:

FOR OFFICE USE ONLY

REG. FEE: $ GRADE:

TUT. FEE: $

UNIFORM: $

ADDITIONAL :

INFORMATION