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YBW
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Contact
2011-2012 Online Registration Form
Date: 02-5-12
Registration Type:
New Student
Returning Student
Parent/Guardian's Name:
Student's Name:
Date of Birth:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Mobile Phone:
Email:
Emergency Contact / Relation:
Emergency Phone:
Payment Options:
There are two 16-week semesters. Please select your payment option below.
Pay in full at start of each semester
Make two payments per semester
Payment Status:
Payment must be received before the start of the semester.
I have mailed a check to Ballet Arts Worcester.
I will pay by cash or check in person at the studio.
Class
Instructor
Day/Time
Sub-Total
$0.00
Reg. Fee
$25.00
Total
$25.00
