Today's Date:

Student Name:

Birthdate: Sex: Female Male

Address:

City: State: Zip:

Parent’s Name:

Father’s Employer(s):  

Title: Work Phone:

Mother’s Employer(s):

Title: Work Phone:

Home Phone(s):    

Cell Phone(s):

E-mail:

Please list the names and day/time of the week of each class that you are registering for. (Final placement is subject to the Academy Director’s approval and is based upon the student’s level of development and ability.)

To enroll, press SUBMIT.

Note:  There is a $25.00 registration fee per family, due with your first tuition payment. You may pay with cash, check (made payable to the Peoria Ballet), Visa or Mastercard.

Please write child's name in memo of all checks. 

If a student drops a class a drop slip must be turned in if a slip is not received you will be responsible for payment of lessons until Office is notified in writing.

Payment Info 

     Total:$

Pay by Check

Pay by Credit Card (Visa or Mastercard)

Pay by Cash

Please Mail or Bring in Cash, Check or Credit Card Information  

Send Check or Money to Peoria Ballet - 8800 N. Industrial Road - Peoria, IL 61615

    Or Bring in on First Day of Classes

___________________________________________________________________________________

Add/Drop Slip

Student's Name

Date

  Adding        Dropping

Class   Day Monday Tuesday Wednesday Thursday Friday Saturday Select One   Time

Reasons for Dropping: