Academy of Ballet Etudes
104 Wall Street, Norwalk, CT 06850 203.838.1888
abetudes@aol.com www.balletetudesct.com
2010 Summer Registration Form
Student’s Name: ___________________________________________________Age: _______________
Date of Birth: ______________Grade: _____ Academic School: ___________________________
Street Address: _____________________ ______ Town: __________________ Zip: ______________
Home Phone: _________________ Cell #: _________________ Emergency#: _________________
Parent’s Email: _______________________________ Student’s Email: _________________________
Mother’s Name: ___________________________Father’s Name: ______________________________
Tuition (see below for fee schedule) _________________________
10% Family discount (deducted from one (lowest) tuition
when more than one child is enrolled.) ______________________________________
5% handling fee for Credit Card Charge ___________________________________
TOTAL DUE _________________________
Deposit (half due at registration) _________________________
Balance due (first day of class) _________________________
I have read and agree with all Academy policies listed in the brochure. I understand that there are no cash refunds. Credit may be given in special circumstances.
Parent Signature: _______________________________________________________________________
Payment by cash: ________ Check #: ________ (Visa/MC +5%) Credit Card #: ____________________________
Signature: _______________________________ Exp: __________________ Zip: __________CV2: ___________
Please check or circle Sessions, Level, Camp or Intensive you will be attending below.
Session II (July 26 – Aug. 18) ___
Pre Ballet (3 & 4 year olds) Mon/Wed 4 weeks (8 classes) $96
Ballet I (5 & 6 year olds) * Mon/Wed 4 weeks (8 classes) $128
Ballet B/C Mon/Wed 4 weeks (16 classes) $256
III/A Intensive Aug. 23-27 Mon-Fri 5 days 9:30-3:30 $475
B/C Intensive Aug. 23-27 Mon-Fri 5 days 9:30-3:30 $475
Advanced Intensive 8/31-9/2, 9/7-9 Tue-Thu 6 days 3:00-5:30 $240
