To register:

We are looking forward to meeting you.
Sincerely, Kelly.

Student's Name
Age/Date of Birth
Home Phone
Academic School/Grade Level
Years in Dance/Type
Previous Dance Teachers
Does the student have any special problems or needs that Blaine Conservatory should be aware of or meet?
Home/Work/Cell Phone
Person to contact in an emergency (Name/Phone Number)
Fee per month$
Costume Fee$
Concert Fee$
Registration Fee$
I the parent or guardian have read and accept the fee policy. I understand that I am responsible for the full fee of the class for which my daughter/son is registering. I agree that I will not hold Blaine Conservatory, or any faculty member, or employee of either, liable for injuries sustained or illnesses contracted by my daughter/son while a student of Blaine Conservatory. I give full permission for Blaine Conservatory to take photographs of my daughter/son to use for purposes of promoting the school.

Signature of Parent or Guardian