Olga’s Russian Ballet School
Registration Form
www.balletelpaso.com
Make all checks payable to the Mind Body Studio
Date: _______________________ Birth Date: _________________________________ Age: ____________
Child’s First Name: ________________________________________Last Name: _______________________________________
Years of completed Dance: _____ School/Instructor: __________________________________ Type: ______________________
Address: ________________________________________________________________________________________________
City: ___________________________________ State: _________________________________ Zip: _____________________
Home Phone: ___________________________________ Parent Work Phone: _______________________________________
Cell Phone: _____________________________Email: ___________________________________________________________
Parent/Guardian: _________________________________________Other Children Enrolled: ____________________________
Person responsible for paying tuition: _______________________________________ Phone: ___________________________
IN CASE OF EMERGENCY’S, PLEASE NOTIFY:
Name: ___________________________________ Relationship_________________________ Phone: ______________________
Do you authorize your child to receive medical care: (circle one): Yes No
Doctor: ________________________________ Phone: __________________ Hospital: _________________________________
Please list any medical or physical impairment’s we may need to know about: ___________________________________________
I do not hold Olga’s Russian Ballet School responsible for any injury that may occur while my child is participating in or enrolled in
classes at Olga’s Russian Ballet School. I am registering my child in classes at The Ballet School at my own discretion.
Please sign: ______________________________________________________________________ Date: ___________________
How did you hear about us? Location ____ El Paso Scene ____ Phone Book ____ Website _____
El Paso Times_____ Referral Name ________________________________ Other ____________________________
For Ballet School Use Only:
Date Enrolled: __________________
Classes: ____________________________________ # hrs _______ Tuition Amount: ________________
Registration Fee: ______________ Total Amount Paid: _________________________________________
Olga’s Russian Ballet School
Tuition Payment Options
□ #1 Payment in Full
There will be a 10% discount for anyone who pays the yearly tuition in full
upon registration.
Credit Card Type_________________# _____________________________________Exp _________
Check # ______________________ or Cash _________________
□ #2 Monthly Credit Card Payment
For the value received, I/ We and either of us, jointly and severally, as maker, promise to pay to the order of Olga’s Russian Ballet
School, El Paso TX or it’s assignee, payments of_____ consecutive monthly installments of $ _______ due on the 1 st week of every
month beginning ________,20______ and each month thereafter with final payment on _____________20______.
REQUEST FOR PREAUTHORIZATION PAYMENT PLAN
Olga’s Russian Ballet School
I/ We hereby request the privilege of paying Olga’s Russian Ballet School under the company’s pre-authorized payment plan to draw
items (Visa or MasterCard) for the purpose of paying said payments on the account of
______________________________________________
(Name as Shown on Account)
_________________________________________
(Signature of Authorization)
□
MasterCard Acct # _________________________________________________ Exp. Date ___/___/____
□
Visa Acct # _______________________________________________________Exp. Date ___/___/____
□ #3 Monthly Payments by Cash or Check. This type of payment will be accepted with a
back up of a credit/ debit card number kept in file. CARD WILL BE CHARGED ON THE 16TH OF THE
MONTH WHEN NO MATTER TENDER HAS BEEN RECEIVED (with a $25 late fee). No refunds
will be given for mid month withdrawals.
(Required)
# Credit Card Type __________________ # __________________________________________ Exp Date: ________
Once upon registered, the student will remain on the roster until the end of next semester. If your child decides to
withdraw from the studio prior to the end of semester, a “Student Withdrawal Form” must be filled out by the parent, in
order to stop payments. Payments will cease on the following month
I have read and understood all the information above and take full responsibility for reporting
relevant information about tuition and my child’s attendance.
Parent Signature: ________________________________________________________ Date: ____________________