OFFICE USE ONLY:
Class Level ___________________________________

Deposit Date Paid__________Check or Receipt #_________ Amount     $75
Discount $ ___________ Description _________________________________

First 1/2 Tuition $________Date________ck/csh_________Second 1/2 Tuition__________ Date________ck/csh__________
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San Francisco Youth Ballet Academy
Summer Registration Form 2010

Student’s Name:_______________________________ Birth date: _____________________

Parent’s Name:_________________________________ E-mail:_______________________

Address:_________________________________ City: ______________Zip code: ________

Home phone: ( )_______________________ Work phone ( )_________________

Emergency contact name: _______________________ phone: ( )_________________

Class, Day and time preferred*:________________________ _________________________
*please refer to the level stated at the top of the form and choose from the classes highlighted in the schedule.
(student will not be admitted to class unless this portion of the form is completed) 911 will be called in extreme emergency.

Health/Other issues teacher should know about (i.e. medication, allergies, physical):

I am interested in volunteering for SFYBT performances and/or becoming a member of the SFYBT board. Yes ____ No____
List Special Skills/Interests: ____________________________

I have received & read and understand the policies of SFYBA. Yes______ No_____
I understand the tuition payment schedule. Yes______ No______
I hereby authorize SFYBA to use any and all photographs taken of my child. Yes______ No______

__________________________________________________________________
(Signature Parent/Guardian) (Date)
SFYBA reserves the right to deny services for non-compliance with the academy policies and philosophy.