Bonita's School of Ballet


Student Name
Date of Birth
Age as of September 1st, 2011
Parent/Guardian Name
Address
Home Phone
Work Phone
Mother's Cell
Father's Cell
Student's Cell (if applicable)
Email Address
Health Concerns or Allergies
In Case of Emergency Contact(s) and Phone Number(s)
Although every effort is made to create a safe environment, I realize there is always a risk of accident. If necessary, I authorize Bonita’s School of Ballet to administer first aid treatment and/or emergency treatment for my child on my behalf. I further release Bonita’s School of Ballet and its employees from liabilities for injury or damages arising out of personal injury of any kind. I Agree (This will act as an electronic signature)
Bonita’s School of Ballet is granted permission to use dancer’s image in advertisements, news releases and on its website. I Agree (This will act as an electronic signature) I do not agree
Please read and check the following to signify that you understand studio policies. (The check will act as an electronic signature)
There is a registration fee of $25 for new students and $20 for returning students due at the time of registration. I Understand
Tuition payments are due on or before the first day of each month. After the 10th of each month, a $10 late fee will be applied to all late payments. I Understand
All returned checks will incur a $35 fee. I Understand
Students with unpaid tuition may not be allowed to participate in class until fees are paid in full or arrangements have been made. I Understand
Missed classes & tuition payments are not refundable. Students should contact studio directly to inquire about attending another age appropriate make up class. Refer to studio policies for more details. I Understand
Each student who is performing in the recital will need to pay a $40 Recital Fee. I Understand
Recital Costume deposits of $25 must be paid by the first week in November and the balance is due in January. Costume payments are non refundable. I Understand
In the following boxes, please list the classes that you would like to sign up for. If you have any questions about level placement please contact us either by phone (704-289-5733) or by email (bonitasballet@yahoo.com).
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