Registration

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Come Dance with the Ballet Bunny! Crafts, story time, dancing, decorate you own Easter cookie and loads of fun with the Ballet Bunny! Once you register please log into your parent portal account from our home page of our website using the email you used to sign up. We will bill you your $20.00 balance 2 weeks before the event.

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Information*

Students entered below will be added to your family's account

Add New Student #1:

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	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)
	Student Email:
	School:	Grade Level:
	Disabilities (Leave blank if NONE):
	Allergies (Leave blank if NONE):
	Medications (Leave blank if NONE):
	Primary Doctor:

Additional Information:

Release of Liability

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I've read the above and agree.

Medical Emergency

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I've read the above and agree.

Consent of Photography/Video

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I've read the above and agree.

Charge Date is 14 Days before Event

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I've read the above and agree.

Enter your Full Name: