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:_________________________________