New Mexico Ballet Company School Online Registration

Registration

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Welcome to New Mexico Ballet Company School! Please complete the following registration form for enrollment in 2019-2020 classes. New students: your first class is free! Please fill out the form and enroll as a trial for your first class. Registration opens on August 3, 2019. Call 505-659-8523 for questions.

* 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
(Not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

Last Name *

Relation*

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

Contact #2

Contact #2 First Name

Last Name

Relation

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender

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

Cell #

Additional Info

Student Email

T-Shirt Size

School

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Years of dance experience

Interest in Youth Company?

Interest in ADC Team?

Please click on the Search button below, then select your desired class(es).

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

School

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Years of dance experience

Interest in Youth Company?

Interest in ADC Team?

Please click on the Search button below, then select your desired class(es).

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

School

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Years of dance experience

Interest in Youth Company?

Interest in ADC Team?

Please click on the Search button below, then select your desired class(es).

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

School

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Years of dance experience

Interest in Youth Company?

Interest in ADC Team?

Please click on the Search button below, then select your desired class(es).

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

School

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Years of dance experience

Interest in Youth Company?

Interest in ADC Team?

Please click on the Search button below, then select your desired class(es).

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Assumption of Risk

I understand there is an inherent risk of potential injury associated with dance classes. I represent the above named student is physically capable of participating in dance classes.

I've read the above and agree.

Release of Liability

I hereby waive and release any claim against New Mexico Ballet Company (NMBC), their staff, employees, landlord and contractor, arising out of personal injury occurring in connection with classes or otherwise in or around the dance studio.

I've read the above and agree.

Medical Emergencies

I accept responsibility for obtaining appropriate accident, health and hospitalization insurance to cover the student in event of personal injury. In the event of an injury or other medical emergency, if I cannot be reached, I authorize NMBC to seek any medical assistance reasonably required and I agree to be responsible for medical expenses incurred on behalf of the student.

I've read the above and agree.

Photo Release

I agree to allow NMBC to use photographs and/or videos of the above mentioned student on its website and in advertising materials.

I've read the above and agree.

Payment Policy

I understand that I am responsible for timely payment of tuition and agree to pay all costs for collection of any unpaid tuition and fees as well as any finance charges assessed by NMBC.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Account Information

Payment Plan*

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*