Registration Form

Submitted by admin on Tue, 11/27/2012 - 22:56

Summer 2017 SEATTLE
Session A:
June 5-26 at Soma Yoga in Ballard with Darrah Blanton
Mondays:
2:15-3:05 pre-ballet ages 4-5
3:15-4:05 pre-ballet ages 3-4
4:15-5:05 ballet ages 5-7
$68 (4 weeks)
Session B:
July 5-August 2 at Soma Yoga in Ballard with Inès Andrade
Tuesdays 9:10-10:00 pre-ballet ages 3-5 $68 (4 weeks)
OR
Wednesdays 10:30-11:20 pre-ballet ages 3-5 $85 (5 weeks)

Click on the class drop down menu for class availability. After you submit the form you will receive an email confirming your registration was received, usually within 2 business days. If you don't see it in your inbox, please check your junk mail. Any problem with registering, please call Darrah's cell at 206-281-9815.
Please be sure to read the policy regarding parents viewing classes on the FAQ page before submitting registration.
DB=Instructor is Darrah Blanton IA=Instructor is Inès Andrade

Class: *

Student Name: *

Date of Birth: *

Phone (Cellular): *

Phone (Work): *

Phone (Home): *

Phone (Emergency): *

Parents’ Names: *

Address 1: *

Address 2:

City: *

Zip: *

Email address: *

Please describe any special needs or health history you would like me to be aware of:

Release Form: *

I agree to let my child participate in the dance program of Darrah Blanton, and hereby release Darrah Blanton and/or Inès Andrade from liability for any injury my child may incur as a result of their participation.

Release signature: *

Type the name of the parent or guardian completing the form.

Release Date: *

Photo Release: *

Allow the use of photographs and/or video of my child

Please refrain from using photographs and/or video of my child

Periodically the website is updated with photos and/or video. Please indicate above whether you would allow photos and/or video of your child to appear online at
www.darrahblantondance.com and to be used in printed materials for advertising purposes.

Refund Policy: Refunds/credits are not available after May 1 for Summer classes. Cancellations prior to this date will incur a $20 cancellation fee per registration.: *

I understand and agree to the refund policy.

How did you hear about us?: *

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