Bluegrass Youth Ballet

Enrollment 2012-2013

Enrollment Form

Please complete the following form and simply click the "Submit" button once. Administrative staff will contact you shortly.

Or, you can download the following Enrollment Form for Pre-Ballet - Level H & Adults in PDF format or Enrollment Form in Word format, fill in the information and send it back to us. Our address is 1595 Mercer Rd., Suite 150, Lexington, KY 40511.

PDF Word

Or, download the following Enrollment Form for Baby Ballet & Creative Movement in PDF format or Enrollment Form in Word format, fill in the information and send it back to us.

PDF Word

If you have any questions about enrolling in BYB, please call 859-271-4472.
Our staff can assist you. Thank you.

If adult student, only answer 1, 2, 6, 7, 8, 10, 12, 13, 19, 20, 21.

* indicated required field, which information must be provided in order to submit the enrollment form successfully. If any of the required field is not applicable, please enter n/a and proceed to the next question.

1. Which class are you enrolling for (including level, day and time)?
*

2. Student's Name: *

3. Age:    4. Date of Birth:    5. School Grade:

6. Home Address: *

7. City: *, KY   8. Zip Code: *

9. School Attending:

10. Home Phone: *

11. Parent Cell: *   12. Student Cell: *

13. Mother's/Student's Email: *

14. Father's Email:

(Your Email address will be used for BYB communicative purpose only. Please submit your current Email address.)

15. Mother's Name:

16. Mother's Employer:   Phone:

17. Father's Name:

18. Father's Employer:   Phone:

19. Training:
*

20. Medical Conditions:
*

21. How did you hear about BYB?:
*

Tuition Agreement
($25 annual registration fee due upon enrollment; $10 additional family member)
BYB offers payment options on tuition for your convenience. If you need to withdraw BYB requires a written 30-day notice. (See BYB rules and policies) Please choose one of the following options.*
Pay in Full for Semester
Pay in 2 Installments per Semester (See Calendar for Tuition Dates)
Pay in 4 Installments per Semester (See Calendar for Tuition Dates)
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Baby Ballet: $60 per Session
Creative Movement: $100 per Session


Waiver of Liability:
I, the undersigned unconditionally release and discharge Bluegrass Youth Ballet, inc. and its faculty and staff, employees, directors and volunteers from any and all liability arising from, related to, or connected with any injury, illness or damage caused by, resulting from, or sustained in the course of my participation in classes, performances or other activities conducted by or associated with Bluegrass Youth Ballet, inc. I hereby attest that this Waiver of Liability is provided voluntarily and shall by fully binding upon my heirs, next-of-kin, executor, administrator and/or personal representative. *

I HAVE READ AND UNDERSTOOD THE BLUEGRASS YOUTH BALLET RULES AND POLICIES. You can also see them posted on our website: www.bluegrassyouthballet.org/rules.html *

Periodically, BYB and other photographers take photos of students for promotional materials. Please check below your preference for the above named student to be photographed. *
YES, I give permission for the above named student to be photographed.
NO, I do not give permission for the above named student to be photographed.