Student Registration Form
Please contact Los Gatos Ballet to schedule a placement class.
* Required field
Student Information
First Name *
Last Name *
Date of Birth *
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Day
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Previous studio/ instructors
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List any conditions of which we need to be aware
How did you hear about Los Gatos Ballet?
Parent Information
First Name *
Last Name *
Home Phone *
Cell Phone
E-mail *
Address *
City *
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Zip *
Place of Employment
Work Phone
Work E-mail
Emergency Contact *
Relationship *
Phone #1 *
Phone #2
Waiver & Release
The undersigned hereby releases, acquits, forgives and discharges Los Gatos Ballet and Pilates, BIM Inc. and all its contractors from any actions, claims, demands, suits, agreements, judgments, liabilities and proceedings, whether arising in equity or law, and in particular, arising from loss, damage, liability, suspicion, injury, pain, cost or expense that may arise during or be caused in any way by participation in any and all activities hosted by Body In Motion. This release shall remain binding upon all successors in interest and personal representatives of the contracting parties, to the extent permitted by law.
Agrees to the Conditions
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