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Personal information
Student Name*
Date of Birth*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Student's cell phone*
Current Ballet (Dance) School*
Number of years in ballet*

Contact Information
School information and announcements will be distributed through email, please provide a reliable email address and be sure that www.karpovbaletacademy.ca is on your safe list.
Parent e-mail*
Student's email*
Parent Name*
Parent cell phone*
Please select weeks attending*
- August 4 - 14
- August 17 - 27

- I have read the registration information and understand the Academy policies as outlined at www.karpovballetacademy.ca
- I understand that this registration contract represents a financial commitment. There are NO REFUNDS on class fees unless the program cancelled by school. Should student sustain an injury that prevents her/him from completing Summer Program KBA will (with a doctor’s note) transfer any unused fees to KBA future classes. No exceptions.
- I certify that my child is in good health and capable of participating in all classes.
- I hereby give permission for Karpov Ballet Academy to take photographs/videos for promotional use.
- I understand that Karpov Ballet Academy cannot be responsible for any lost or stolen items.
Consent*
I agree with the above rules*