Blaine Conservatory Registration

To register:

Please print the registration form and mail it to the Conservatory with your $15 registration fee.
OR
Please call the studio and make an appointment to come and take/observe class and register on site.

We are looking forward to meeting you.
Sincerely, Kelly, Diane and staff.

Student's Name	Age/Date of Birth
Address	Home Phone
City/State/Zip	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?

Parent/Guardian
Address
City/State/Zip
Home/Work/Cell Phone
Person to contact in an emergency (Name/Phone Number)

Class
Fee per month	$
Costume Fee	$
Concert Fee	$
Registration Fee	$
	==========
Total	$

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