Registration

Student's Name: _______________________________________ Birthdate: _________________________ Age: ___________

Parent 1 Name: ________________________________ Phone #: _______________________ Email:______________________________

Parent 2 Name: ________________________________ Phone #: _______________________ Email: _____________________________

Address: ________________________________________________________ City: _____________________________ Zip: ___________

School: ___________________________________________________ Grade: ___________ Dismissal Time: _______________

Previous Dance Training: ___________________________________________________________________________________________

___________________________________________________________________________________________________________________

How did you hear about Oregon Ballet School?   Google:_____   Website:_____   Recommended By:______________________

                                                                            Other:_________________________________