Registration
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Registrations must be accompanied by a tuition installment or payment in full, including the annual registration fee. Accounts will automatically be charged per the Payment Plan selected when reviewed and processed by the School Administrator. Any pertinent discounts or adjustments to the catalog pricing will be assessed in processing.
How did you hear about us? *   Referral Name:         * - denotes required fields
Family Information:
Family Name:
Primary Contact First Name:* Last Name: * Type:*
Home Phone: * Cell #: Work #:
Email:* (Emails are kept confidential)
 
Employer:
Employer Phone:
Employer Notes:
 
Secondary Contact First Name: Last Name: Type:
Home Phone: Cell #: Work #:
Email: (Emails are kept confidential)
 
Employer:
Employer Phone:
Employer Notes:
 
Home Address: *
City: * State: * Zip: *
Home Phone: *
Emergency Contact Info:*
(Not Primary Contact, Secondary Contact)
Health Insurance Carrier:
Summer Chaperon Applicant Name:
 

Student #1 Information:
Student's First Name: * Last Name: *
Student Gender:  Birth Date: * (format=mm/dd/yy)  
Student Email:
Academic School: Ballet Class Level:
Special Needs:
Allergies:
Medications:
Prior Dance Training (Please include dance styles, school, city, state, teachers, summer programs):*
Summer Session: Type 1 &/or 2:
Summer Housing Needed:
Summer RA Applicant Name:
Class size is limited. The Louisville Ballet School reserves the right to close classes when filled or to cancel classes due to lack of enrollment. Please submit a complete registration form for each student.

Classes (max 15)
Select Class #1: * _______________   
Select Class #2: _______________   
Select Class #3: _______________   
Select Class #4: _______________   
Select Class #5: _______________   

Student #2 Information:
Show-Hide Details
Student's First Name: Last Name:
Student Gender:  Birth Date: * (format=mm/dd/yy) 
Student Email:
Academic School: Ballet Class Level:
Special Needs:
Allergies:
Medications:
Prior Dance Training (Please include dance styles, school, city, state, teachers, summer programs):*
Summer Session: Type 1 &/or 2:
Summer Housing Needed:
Summer RA Applicant Name:

Classes (max 15)
Select Class #1: * _______________   
Select Class #2: _______________   
Select Class #3: _______________   
Select Class #4: _______________   
Select Class #5: _______________   

Student #3 Information:
Show/Hide Details
Student's First Name: Last Name:
Student Gender:  Birth Date: * (format=mm/dd/yy) 
Student Email:
Academic School: Ballet Class Level:
Special Needs:
Allergies:
Medications:
Prior Dance Training (Please include dance styles, school, city, state, teachers, summer programs):*
Summer Session: Type 1 &/or 2:
Summer Housing Needed:
Summer RA Applicant Name:

Classes (max 15)
Select Class #1: * _______________   
Select Class #2: _______________   
Select Class #3: _______________   
Select Class #4: _______________   
Select Class #5: _______________   

Student #4 Information:
Show/Hide Details
Student's First Name: Last Name:
Student Gender:  Birth Date: * (format=mm/dd/yy) 
Student Email:
Academic School: Ballet Class Level:
Special Needs:
Allergies:
Medications:
Prior Dance Training (Please include dance styles, school, city, state, teachers, summer programs):*
Summer Session: Type 1 &/or 2:
Summer Housing Needed:
Summer RA Applicant Name:

Classes (max 15)
Select Class #1: * _______________   
Select Class #2: _______________   
Select Class #3: _______________   
Select Class #4: _______________   
Select Class #5: _______________   

Student #5 Information:
Show/Hide Details
Student's First Name: Last Name:
Student Gender:  Birth Date: * (format=mm/dd/yy) 
Student Email:
Academic School: Ballet Class Level:
Special Needs:
Allergies:
Medications:
Prior Dance Training (Please include dance styles, school, city, state, teachers, summer programs):*
Summer Session: Type 1 &/or 2:
Summer Housing Needed:
Summer RA Applicant Name:

Classes (max 15)
Select Class #1: * _______________   
Select Class #2: _______________   
Select Class #3: _______________   
Select Class #4: _______________   
Select Class #5: _______________   
 
Enter your Full Name: *   
 
 
Comments:  

Payment Plan:*  
Please fill out ONE of the following Payment Methods:
 
Credit Card Verification:
   
Name as it appears on card:  
Card Type:   Card Number:  
Card Expiration Month:   Exp Year:  
 
eCheck/Bank Draft:
Bank Name:
Bank Routing Number: (9-digit number)
Your Account Name: (Your name on your bank statement)  
Your Account Type:   Account Number:  
 
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