Registration


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 Info (Not Contact #1 or #2)
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Gender (M/F)*
Height:*
Years of Ballet training:*
Years on pointe:*
Current classes you are taking at CBC:*
Have you ever attended any intensive summer dance programs?*
If yes, where, when, and what level were you?
Names of Director & present teachers:*
List most recent companies and/or ballets performed with/in:*
 
Additional Information:
 
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*