Private Lessons Registration Form

Please complete the Private Lesssons Registration From before taking any individual instructions at OBA.

We’ll contact you to schedule the date/time convenient for you.

Student

First Name

Last Name

Parent / Guardian

First Name

Last Name

Phone number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student's gender

Date of birth

YYYY

Level for Placement Class

Preferred Date for Placement Class

YYYY

Previous ballet training

Years of training, Level, Ballet School Name

Days per week / hours per week of training

Number of years on pointe

Other forms of dance training

Academic school/preschool

Grade

Physical conditions

List any conditions the staff should know about (allergies, medications, injuries, etc.)

How did you hear about us

Comments

Please list goals you wish to achieve and any other information we need to know, like possible dates/times that work for you for easy scheduling

I have read and agree to the Policies and Waiver of liability as noted on these pages https://www.osipovaballetacademy.com/policies , https://www.osipovaballetacademy.com/privacy-policy . I confirm that I am legally able to do this on behalf of the student I am registering.