Child's Name *
Child's Name
Child's Date of Birth *
Child's Date of Birth
Parent/Guardian Name (1) *
Parent/Guardian Name (1)
Parent/Guardian Name (2)
Parent/Guardian Name (2)
Contact Number *
Contact Number
Secondary Contact Number
Secondary Contact Number
Injury and Emergency Treatment Waiver (Parent/Guardian's Name) *
Injury and Emergency Treatment Waiver (Parent/Guardian's Name)
I, the parent/guardian of the minor/student above, understand that there is a risk of personal injury associated with ballet classes, rehearsals and performances. I state that the minor/student above is in good health and is physically capable of participating in ballet classes, rehearsals and performances. I therefore release, discharge and/or otherwise indemnify the Ballet Class of Rye, LLC, Celeste Morningstar, her faculty or family of any claim that my arise out of a personal injury occurring in connection with ballet classes, rehearsals or performances in and around the dance studio or at the location of rehearsals or performances. I, the parent/guardian, accept responsibility for obtaining the appropriate insurance to cover the minor/student above the event of personal injury. If I cannot be reached, I give my consent for the Ballet Class of Rye, LLC to seek any medical assistance required and I agree to be responsible for all medical expenses incurred on behalf of minor/student.
Today's Date *
Today's Date
Best phone number to reach you in case of an emergency.
Photo Release (Parent/Guardian's Name) *
Photo Release (Parent/Guardian's Name)
I, the parent/guardian hereby consent to the use of photographs and videos of the child listed above by the Ballet Class of Rye, LLC for advertising and promotion in perpetuity in all media including but not limited to print and the internet. I agree not to hold the Ballet Class of Rye, LLC, Celeste Morningstar, her faculty or family responsible for any action the occurs from any misuse or unauthorized use of these images. If I would not like my child's image to be used, I will state so in the last box of this Registration Form.
Today's Date *
Today's Date
If for any reason you do not want your child's image to be used, you must state so in this boxed portion below.

We accept cash, check or credit card payments. If you prefer to pay with credit card, please fill out and submit this form. Otherwise, print, fill out this form, and mail us a check for the full amount of tuition made out to Ballet Class of Rye, LLC. 

Mail to: The Ballet Class, P.O. Box 252, Rye, NY 10580.