Eudora Ballet
Online Registration Form


Select which program you are currently registering


Name of Student/Information:















Parent(s)/Guardian Information:
































Emergency Contact other than parents/guardian:















Student Dance History/Experience:










Please Read the below and click accept in order to continue registration:













Parent/Guardian Electronic Signature:










Thank you for completing your online registration page.  Once you hit submit, your information will be submitted for registration. To complete your registration, a registration fee of $25 is required.  You may pay your registration fee online (Go to Registration page and click online payments), mail in payment, or pay directly to the Eudora Ballet during classes.  Make checks payable to Elisa Batts.  A Liability Release Form and Students Medical History form will also be required before the student begins the program.

By clicking the submit button, I admit that all information is true on this page:


I/We understand it is very important for the student to attend all classes. In order for a student to be included and participate in program dance concerts, I understand the importance of the student to attend classes.  I further understand that Eudora Ballet will require the best that the student can accomplish.  Each class will be required to work on a piece for the concert(s). Each student will be placed according to his/her ability to listen to instruction, student's attitude, and their ability to execute what they are being taught.  I/we understand this will play a large roll in the placement of the students classes and choreography.

By clicking on the below, I have stated that I have read the above regarding placement and attendance.
In order to submit this form online by electronic means, you, as authorized representative, will be required to use an electronic signature by use of typing out your full name and placing your initials in the box below.   You agree to all terms and conditions presented in this Electronic Signature Agreement. Please be aware that an electronic signature is as legally binding as a handwritten signature.
First Name                   MI    Last                                   Age
Address
City                           State                    ZipCode
Home Phone (###-###-####)                   Student Mobile (###-###-####)
Student E-mail Address (if applicable)
First Name                              MI            Last
Address (If different from student address)
City                             State                  ZipCode
Home Phone (###-###-####)                  Mobile (###-###-####)
E-mail Address
First Name                               MI          Last
Address (if different from student or Parent 1)
City                                   State                   ZipCode
Home Phone (###-###-####)                          Mobile (###-###-####)
E-mail Address
First Name                               MI           Last
Address
Home Phone (###-###-####)                     Mobile (###-###-####)
E-mail Address
City                     State              ZipCode
Yrs of Ballet                           Dance School/Program
Yrs of Modern                          Dance School/Program
Other forms of dance?                              No. of Yrs
Electronic Signature/Confirmation
Type your full name above and provide your initials  the preceding box
FatherMotherOther/Guardian
FatherMotherOther/Guardian
AcceptDo Not Accept (Cancel Registration)
FALLSPRINGSUMMER