Pas de Vie Ballet 2019-2020 Registration form

To see the list of class offerings, click here


Name *
Enter the name of the student
Name of Parent or Guardian *
Name of Parent or Guardian
if the student is under 18
Student Birthdate *
Student Birthdate
Primary Address *
Primary Address
Primary Contact Phone *
Primary Contact Phone
Does this number accept text messages? *
Additional Phone
Additional Phone
Does this number accept text messages?
Name of Emergency Contact *
Name of Emergency Contact
Emergency Contact Phone Number *
Emergency Contact Phone Number
Consent *
I am aware of the inherent risks involved from participating in this activity. In the event of an accidental injury, I authorize Pas de Vie Ballet representatives to secure medical care for my child if I cannot be reached. I release Pas de Vie Ballet from any liability for injury resulting from participating. I know of no mental or physical problems which may affect my child's ability to safely participate in this activity. I will be responsible for any medical or other charges in connection with my child's attendance. I agree to abide by all Pas de Vie Ballet rules, policies, and procedures and to respect the decisions of the instructors made in the course of performing their duties. I assume full responsibility that the child I am registering does the same, and acknowledge that failure to abide by all rules may result in the removal of my child from this activity. *Agreeing to this shall constitute that you have read the above, and this shall be construed as a binding signature of consent.
Class level is subject to approval from the directors. If you are unsure of your class level, please email info@pasdevieballet. Class descriptions can be found under the 'classes tab'
Upon completion of the registration form, you will receive an invoice reflecting your choice.