Indiana Ballet Conservatory Inc. Online Registration

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

IBC Placement

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Name of Insured or Type N/a*

Member ID# or Type N/a*

Student Member ID# or Type N/a*

Provider Phone # or Type N/a*

Please select your approved level. Once you complete the registration form you may enroll in the suite of classes corresponding to your level within the Parent Portal. The these classes are listed in the description of each enrollment level and each student is expected to attend all corresponding classes to their level. Don't know which level? Please e-mail: contact@indianaballetconservatory.org for further assistance.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

IBC Placement

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Name of Insured or Type N/a*

Member ID# or Type N/a*

Student Member ID# or Type N/a*

Provider Phone # or Type N/a*

Please select your approved level. Once you complete the registration form you may enroll in the suite of classes corresponding to your level within the Parent Portal. The these classes are listed in the description of each enrollment level and each student is expected to attend all corresponding classes to their level. Don't know which level? Please e-mail: contact@indianaballetconservatory.org for further assistance.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

IBC Placement

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Name of Insured or Type N/a*

Member ID# or Type N/a*

Student Member ID# or Type N/a*

Provider Phone # or Type N/a*

Please select your approved level. Once you complete the registration form you may enroll in the suite of classes corresponding to your level within the Parent Portal. The these classes are listed in the description of each enrollment level and each student is expected to attend all corresponding classes to their level. Don't know which level? Please e-mail: contact@indianaballetconservatory.org for further assistance.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

IBC Placement

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Name of Insured or Type N/a*

Member ID# or Type N/a*

Student Member ID# or Type N/a*

Provider Phone # or Type N/a*

Please select your approved level. Once you complete the registration form you may enroll in the suite of classes corresponding to your level within the Parent Portal. The these classes are listed in the description of each enrollment level and each student is expected to attend all corresponding classes to their level. Don't know which level? Please e-mail: contact@indianaballetconservatory.org for further assistance.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

School

IBC Placement

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Name of Insured or Type N/a*

Member ID# or Type N/a*

Student Member ID# or Type N/a*

Provider Phone # or Type N/a*

Please select your approved level. Once you complete the registration form you may enroll in the suite of classes corresponding to your level within the Parent Portal. The these classes are listed in the description of each enrollment level and each student is expected to attend all corresponding classes to their level. Don't know which level? Please e-mail: contact@indianaballetconservatory.org for further assistance.

Enroll in Classes

Select Class

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

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Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Student #1

Additional Info

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Student #2 (Show-Hide Details)

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Student #5 (Show-Hide Details)

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Enroll in Classes

Required Policies

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I Agree to All of the Above

Questions or Concerns

Payment Information

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?

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

Required Policies

(Show-Hide Details)