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Hannah's Ballet ~ Registration Form Fall 2021

Fall Ballet Program Details - Begins 09/30/21 ~ Ends 11/18/21

Cost: $100 (for 8 classes)
All parents/guardians MUST read the COVID Procedures page on this website before signing up your dancer.

If for any reason we are not able to finish our in-person classes (due to COVID), I am committed to offering virtual classes in place of any we are unable to do in person!
Classes have a maximum of 10 dancers and a minimum of 6 dancers to run

Registration Deadline: Students must be signed up online by September 1st, 2020

* Indicates required field

Dancer's Full Name *

First

Last

Class you are signing up for *

Thursday K-2 Ballet Class (4-5pm) Thursday 3-6th Grade Ballet Class (5:15-6:15pm)

Dancer Age (As of Sept. 2021) *

Dancer Grade (Fall 2021) *Dancers must be in kindergarten to sign up for class * *

Parent/Legal Guardian Name *

Parent/Legal Guardian Phone *

Parent/Legal Guardian Email *

Parent/Legal Guardian Address *

Second Parent/Legal Guardian Name *

Second Parent/Legal Guardian Phone *

Second Parent/Legal Guardian Email *

Emergency Contact Person (other than parent) *

Relation to Dancer *

Emergency Contact Person Phone *

Who does the dancer live with? *

Who has permission to pick up your dancer? Please list names and relations to the dancer. *

Any known medical conditions/allergies? *

Does the dancer carry an epi-pen or inhaler? *

Do you give photo release permission for your dancer? (Photos may be used on website) *

Yes No

Do you have any other concerns or things we should know about your dancer? *

I/WE PROMISE THAT MY/OUR DANCER WILL NOT ATTEND OUTDOOR BALLET CLASSES IF THEY HAVE ANY OF THE FOLLOWING SYMPTOMS : FEVER, COUGH, SHORTNESS OF BREATH OR DIFFICULTY BREATHING, BODY ACHES, NEW LOSS OF TASTE OR SMELL, SORE THROAT, CONGESTION OR RUNNY NOSE, NAUSEA OR VOMITING, DIARRHEA. PLEASE SIGN BELOW *

I/WE REALIZE THAT PARTICIPATION IN DANCE CLASSES AND ACTIVITIES COULD RESULT IN SOME POSSIBLE PERSONAL INJURY, OR EXPOSURE TO COVID-19. DESPITE PRECAUTIONS BEING TAKEN BY Hannahs ballet, ACCIDENTS, INJURIES, OR EXPOSURE TO COVID-19 RESULTING IN CONTRACTING THE VIRUS MAY OCCUR. BY SIGNING THIS RELEASE FORM, I/WE (THE DANCER AND PARENT/GUARDIAN) ASSUME ALL RISKS RELATED TO participation in Hannah’s ballet classes and the USE OF ANY AND ALL SPACES USED BY HANNAH'S BALLET. PLEASE SIGN YOUR NAME BELOW *

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Hannah's Ballet ~ Registration Form Fall 2021

Location

Contact Me at Hannah.jacobsma@gmail.com or 616-566-2800