Louisville Ballet School Online Registration

Registration

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Registration for Fall and Spring Enrollment must be accompanied by payment of the $30 Annual Registration Fee and $10 Annual LBSCA Membership Fee per family. Registration for Summer enrollment must be accompanied by payment in full and a $30 registration fee for new families. Accounts will be charged per the Payment Plan when reviewed by the Registration & Enrollment Manager. Any pertinent discounts or adjustments to the catalog pricing will be assessed in processing payment.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info*

Health Insurance Carrier

County of Residence*

Discount Code

Contact #1

Primary Contact First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone *

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Secondary Contact First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

Academic School

Ballet Class Level

Transportation

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunizations YN

Immunization Notes (Optional)

Prior Training (If any, please include dance styles, school, city, state, teachers, summer programs)

Student Race/Ethnicity*

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.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

Academic School

Ballet Class Level

Transportation

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunizations YN

Immunization Notes (Optional)

Prior Training (If any, please include dance styles, school, city, state, teachers, summer programs)

Student Race/Ethnicity*

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.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

Academic School

Ballet Class Level

Transportation

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunizations YN

Immunization Notes (Optional)

Prior Training (If any, please include dance styles, school, city, state, teachers, summer programs)

Student Race/Ethnicity*

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.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

Academic School

Ballet Class Level

Transportation

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunizations YN

Immunization Notes (Optional)

Prior Training (If any, please include dance styles, school, city, state, teachers, summer programs)

Student Race/Ethnicity*

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.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Cell #

Additional Info

Student Email

T-Shirt Size

Academic School

Ballet Class Level

Transportation

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunizations YN

Immunization Notes (Optional)

Prior Training (If any, please include dance styles, school, city, state, teachers, summer programs)

Student Race/Ethnicity*

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.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

Payment Plan*

Please fill out ONE of the following Payment Methods

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)