Alabama Ballet School

Registration

Student

Registration

Name of Student *

First

Last

Parent Name *

First

Last

Parent Email *

For main contact, e-newsletter, etc.

Secondary Email (optional)

Parent Phone # *

Best # to reach you during class

Student's Primary Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth (MM/DD/YY) *

Gender

Female
Male
Prefer not to specify

Class Applying For *

All age recommendations are approximate. The faculty will evaluate students and adjust class placement as appropriate. As classes meet capacity, they will be noted as full. You may register for a full class to be added to the waitlist.

If registering multiple students in a family, please list the additional student's full name, DOB and class applying for as well as any information that differs from the primary registrant.

Academic School/School Phone # *

If parents have separate addresses, please list secondary address.

Address Line 1

Address Line 2

City

State

Zip Code

Family Physician *

Phone # *

Any known allergies, medical conditions or medications being taken

so that we can better take care of our students in case of an emergency

Previous dance training (school, teacher, subject, years training, number of classes/week) *

Parent/Guardian Authorization: Please e-sign below by including Parent/Guardian Name, Date, Child's Name. *

I AM AWARE THAT DANCING, AND THE EXERCISES ASSOCIATED WITH IT, PLACE UNUSUAL STRESSES ON THE BODY, AND CARRY WITH THEM THE RISK OF PHYSICAL INJURY. ON BEHALF OF MY CHILD AND MYSELF (AND IF I AM NO LONGER A MINOR, ON MY OWN BEHALF), I ASSUME THE RISK AND AGREE THAT THE ALABAMA BALLET SHALL NOT BE LIABLE IN ANY WAY FOR INJURIES SUSTAINED DURING ATTENDANCE AT THE ALABAMA BALLET SCHOOL OR ANY OF ITS RELATED FUNCTIONS. I GRANT MY CHILD, OR WARD, PERMISSION TO PARTICIPATE IN THE ALABAMA BALLET SCHOOL SESSION. I HEREBY RELEASE AND DISCHARGE THE ALABAMA BALLET, ALABAMA BALLET SCHOOL, ITS AGENTS, EMPLOYEES, AND OFFICERS FROM ALL CLAIMS, DEMANDS, ACTIONS, JUDGEMENTS AND EXECUTIONS WHICH THE UNDERSIGNED’S HEIRS, EXECUTORS, ADMINISTRATORS OR ASSIGNS MAY HAVE, OR CLAIM TO HAVE AGAINST THE ALABAMA BALLET, ITS SUCCESSORS, OR ASSIGNS, FOR ALL PERSONAL INJURIES CAUSED BY, OR ARISING FROM, THE ABOVE DESCRIBED ACTIVITIES, OR ANY ACTIVITIES RELATED THERETO. FURTHER, I GRANT ALABAMA BALLET, THE ALABAMA BALLET SCHOOL, ITS AGENTS AND EMPLOYEES, PERMISSION TO AUTHORIZE ANY EMERGENCY MEDICAL TREATMENT THAT MAY BE REQUIRED FOR MY CHILD, OR WARD, DURING THE SCHOOL SESSION.

Medical Insurance Provider *

Policy Number *

Coverage Dates *

Student e-signature and date *

AS A REPRESENTATIVE OF THE ALABAMA BALLET SCHOOL, I AGREE TO ABIDE BY THE RULES AND REGULATIONS OF THE ALABAMA BALLET SCHOOL.

Student e-siganture and date (Parent/Guardian signature if student is a minor) *

I, THE UNDERSIGNED, HAVE READ THIS RELEASE/AUTHORIZATION AND UNDERSTAND ALL OF ITS TERMS. I EXECUTE IT VOLUNTARILY AND WITH THE FULL KNOWLEDGE OF ITS SIGNIFICANCE.

Student e-siganture and date (Parent/Guardian signature if student is a minor) *

I HEREBY GIVE PERMISSION FOR THE ALABAMA BALLET AND/OR ALABAMA BALLET SCHOOL TO USE PHOTOGRAPHS/VIDEOS OF MY LIKENESS IN ALABAMA BALLET AND/OR ALABAMA BALLET SCHOOL SPONSORED PUBLICATIONS AND FOR PROMOTIONAL PURPOSES.

Student Registration Fee *

Price: $ 30.00

One-time fee per family

Credit Card *

Card Number

Security Code

Name on Card

Expiration/

Message

Registration Form

Address

2726 1st Ave S.
Birmingham, AL 35233

205-322-4300
information@alabamaballet.org

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Alabama Ballet is a 501(c)(3) nonprofit organization

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Press Inquiries:

chloebowen@alabamaballet.org

Alabama Ballet School

Registration

Student

Registration

Address

HELPFUL LINKS

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