Enrollment Form
Please complete this form before taking your first class. Students under 18, please list contact information of parent
or guardian under Emergency Contact portion.
ADULT   CHILD
Student's Name Emergency Contact
Date of Birth Address
Address City
City State / Zip
State / Zip E-mail
Home Phone *Home Phone
Work Phone Work Phone
Billing: Please send my billing to the above address
Please send my billing statements to the following address.
Name Relationship
Address Date of First Class
City
State / Zip
How did you hear about us? Oakland Ballet Performance
Teacher Recommendation
 Newspaper Ad
Dance Magazine
Friend
Television Ad
Performance Review
Yellow Pages
Other		 Previous Training:
  Class Selection: Pre-Ballet (Children 4-6)
Children's Ballet 1,2, or 3
      Classes Per Week:
Adult Ballet 1,2, or 3
      Classes Per Week:
Billing statements are mailed during the second week of the month prior to the month being billed. Payment by check or money order is due by the first of each month. The Academy cannot refund tuition. Missed classes must be made up the following month (except for Pre-Ballet); no refunds for missed classes. In the case of extended absences, change of address, or change in number of classes desired, please notify the Academy in writing.

For billing or general information, please call the Oakland Ballet Academy office at (510) 530-7516.