Registration

Silfida Ballet Academy’s Registration Form

Student’s Name: _____________________________  Home Phone: _________________________

Birth Date: ____/_____/_____      Age: _________    Grade in School: _______________________

Address: ________________________________________________________________________________

City: ____________________________  State: ___________  Zip: __________________________

Parent’s E-mail Address(s):  __________________________________________________________

Mother’s Name: __________________________ Cell Phone: ________________________________

Father’s Name: ___________________________         Cell Phone: _____________________________

Emergency Contact (if Parent(s)/Guardian(s) not available):

Name: ___________________________________ Phone: ___________________________________

Previous Dance Experience: ____________________________________________________________

How did you hear about us?: ___________________________________________________________

Please list all allergies: __________________________________________________________________

List any pre-existing injuries/conditions that may prevent the dancer from fully participating in class:
____________________________________________________________________

3350 NW 2nd Ave, B22
Boca Raton, FL 33431
954-520-4229 or silfidaballetacademy.com