2011-2012 Mobile Ballet School Registration Please complete a registration form for each child attending Mobile Ballet School. You may pay your child's registration fee at the Ballet Store on this site or at the studio. NOTE: The Mobile Studio Primary 3, 4 and 5 classes are full. If you would like your child's name to be placed on the waiting list, please call the Mobile studio at 251-342-2241. The Eastern Shore Studio is still accepting registration for the Primary levels. * Required Field Child's First Name: * Child's Last Name: * Billing Address Street 1: * Billing Address Street 2: City: * State: * AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code: * (5 digits) Child's Age as of September 1, 2011: 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Child's Date of Birth * Child's School 2011-2012: * Child's Grade 2011-2012: * Pre-School Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Child Lives With: * Both Parents Mother Father Grandparent Other Primary Parent/Guardian's Title: * Dr. Mr. Mrs. Ms. Primary Parent/Guardian's First Name: * Primary Parent/Guardian's Last Name: * Primary Parent/Guardian's Home Phone: * Primary Parent/Guardian's Work Phone: * Primary Parent/Guardian's Cell Phone: * Primary Parent/Guardian's E-Mail Address: * Primary Parent/Guardian's Employer: * Primary Parent/Guardian's Title/Position: * Secondary Parent/Guardian's Title: Dr. Mr. Mrs. Ms. Secondary Parent/Guardian's First Name: Secondary Parent/Guardian's Last Name: Secondary Parent/Guardian's Home Phone: Secondary Parent/Guardian's Work Phone: Secondary Parent/Guardian's Cell Phone: Secondary Parent/Guardian's E-Mail Address: Secondary Parent/Guardian's Employer: Secondary Parent/Guardian's Title/Position: Select the ballet level to which    your child was assigned: * ES-Primary 3 ES-Primary 4 ES-Primary 5 MOB-Ballet 1 ES-Ballet 1 MOB-Ballet 2 ES-Ballet 2 MOB-Ballet 3 ES-Ballet 3 MOB-Ballet 4 ES-Ballet 4 MOB-Ballet 5 ES-Ballet 5 MOB-Ballet 6 ES-Ballet 6 MOB-Ballet 7 ES-Ballet 7 MOB-Ballet 8 ES-Ballet 8 MOB-Intermediate ES-Intermediate MOB-Advanced ES-Advanced Are you registering your child for jazz?: * Yes No If yes, select the jazz level to which     your child was assigned: * Beginning Jazz Jazz I Jazz II Indicate which day(s) your child      will attend class(es): * Total number of classes your child     will attend each week: * 1 Class 2 Classes 3 Classes 4 Classes 5+ Classes I have read the Tuition Policy, Hold Harmless Agreement, and Media Agreement included on this registration page and agree to be bound by their terms. I further understand that registration is not complete until the registration fee is paid for my child.  PARENT'S INITIALS *

To pay the registration fee, call 251-342-2241 and provide credit card information.
Thank you!

Tuition Policy:

A completed registration form and non-refundable registration fee are due for each child before attending the first class.

Tuition is calculated as an annual amount, based on the total number of classes. For your convenience, it can be paid in monthly installments and is due by the 10th of each month, from September to May. Tuition not received by the 10th of the month is subject to a $10 late fee.

You will only receive an emailed statement if your account is past due. You are responsible for providing us with your current email address.
We do not prorate tuition for sickness, holidays, or days missed for personal reasons. If you must miss a class due to an illness or another approved reason and would like to make up the class, please see the Associate Director of the School to make proper arrangements.

Mobile Ballet School must be notified in writing, one month in advance, of your intention to withdraw your student. Billing to your child’s account will continue until we receive a written or emailed notification.

Showcase fees and any outstanding tuition must be paid in full by March 12, 2012, in order for your child to participate in Showcase.


Hold Harmless Agreement:

Dancing is a strenuous physical activity and injuries, although not frequent, do occur. By enrolling your child in dance classes at Mobile Ballet, you assume the risk, if any, for any injuries your child may incur while engaged in dance classes, performances, public appear-ances or other related activities, including, but not limited to, necessary travel. By your signature below, you agree to HOLD HARM-LESS Mobile Ballet, its officers, directors, agents, servants and employees from any liability or fault for any injuries your child may incur while engaged in dance classes, performances, public appearances and/or related activities, including, but not limited to, necessary travel.

Media Agreement:

I understand that photographers, television crews, representatives of the media, and/or staff of the School will sometimes be present photographing, filming, or otherwise recording activity at the School and/or activities participated in by students at the School. I agree to permit the School and its designees to use the photographic likeness, video and television recordings, artistic, musical, and written work (the “Likeness and Work”) of the Student for School purposes. I knowingly and voluntarily agree to hold harmless the School regarding the reproduction, publication, or other use of the Student’s Likeness and Work, and further acknowledge and agree that by signing this Agreement, I waive any claim or cause of action I otherwise might have against the School regarding such usage or damages resulting therefrom.