Click Here For: School Year Registration Form

  
Summer 2013 Registration Form
This registration form is seperate from the School year registration form.

Classical Ballet Academy
official school of Ballet Minnesota
St Paul: 249 East Fourth Street, St Paul, MN 55101
Woodbury: Parkwood Place, 7650 Currell Blvd, Woodbury, MN 55125
School director: Cheryl Rist


PLEASE MAIL ALL REGISTRATIONS TO THE ST PAUL ADDRESS

Student Name: (Last)_______________________   (First)__________________

Address: ________________________________________________
City: _______________________   State: _________    Zip: _______________
Birthdate: ____/____/____     Age:_____
   
Home Phone: _(______)_______________________
E-mail:  ____________________________________

Mother/Guradian:_________________________________________________
Phone (H):_(____)_____________
         Phone (cell):_(____)_____________    Email:________________________      

Father/Guradian:_________________________________________________  
         Phone (H):_(____)_____________
         Phone (cell):_(____)_____________    Email:________________________      

How did you find out about CBA:
         (     ) Friend          (     ) Poster          (      ) Performance          (      ) Ad    
         (     ) Internet       (      ) Flyer            (     ) Yellow Pages          (     ) Mail
         (     ) Other:_______________________

Course:
         (     )  17th Minnesota Dance Camp:   MInimum of 2 weeks enrollment required:  
                         Week 1(   ), Week 2(   ), Week 3 (    )
                         $75.00 non-refundable fee must accompany Registration
         (     )  7th Mini Camp ( 2 weeks)
                         $75.00 fee must accompany Dance Camp registration
         (     )  Pre-Ballet Workshop  ( 5 weeks ) ..... St Paul (   )   /  Woodbury (   )
         (     )  Regular Summer Classes  ( 7 weeks )  
                         Level 1-2      ____Tuesday / Thursday 6:00 - 7:00pm
                         Level 3-4      ____Tuesday 5:00 - 7:00pm
                                              ____Thursday 4:30 - 6:00pm
                         Level 4-8      ____Monday 4:30 - 6:00pm
                         Level 5-8      ____Tuesday 4:30 - 6:00pm
                                              ____Thursday 5:00 - 7:00pm

Parent/Guardian:
Your signature below indicates approval and permission of the following:

     1. Please inform staff of any medical conditions which might affect class participation.
     2 The parent or guardina agree that in case of medical emergency, after every reasonable effort has been made to contact them, to have the physician secured by the adult in charge of activities to hospitalize, secure treatment for and to order injection, anesthesia or surgery for the child. In the event any such treatment is not covered by insurance applicable to the activities, the parent / guradian will pay the expenses incurred in such emergency treatment.
     3.  Classical Ballet Academy, employees or guests shall not be held responsible for injury or illness to a student while student is attending classes or performing with CBA or Ballet Minnesota
     4. Any photos taken by CBA or Ballet Minnesota of a CBA student, while enrolled in CBA (during class, rehearsal or performance), may be used by CBA or Ballet Minnesota for advertizing, promotion, publication purposes.

        (parent / guardian must sign this form in order to have a child registered at CBA)

Signature:_______________________      Date:_____________
.