Cassandra Macino / Artistic Director
3157 Sylvania Ave., Toledo, OH 43613
Registration Form
Please Complete The Following Enrollment Steps:
1.) Enter enrollment information into the form below and press the "Submit" button.
2.) After pressing "Submit" you will be taken to a separate page to make your payment.
Payments may be made using the following credit cards: VISA, MasterCard, Discover, Amex.
Thank you for enrolling with Cassandra School of Ballet!
Student's Name:
Today's Date :
Date of Birth:
Student's Cell Phone:
(Include Area Code) xxx-xxx-xxxx
Student's Email Address:
Student's Home Address:
Zip Code:
Home Phone:
(Include Area Code) xxx-xxx-xxxx
Father's Name:
Mother's Name:
Father's Employer:
Mother's Employer:
Father's Work Phone:
(Include Area Code) xxx-xxx-xxxx
Father's Cell Phone:
(Include Area Code) xxx-xxx-xxxx
Mother's Work Phone:
(Include Area Code) xxx-xxx-xxxx
Mother's Cell Phone:
(Include Area Code) xxx-xxx-xxxx
Father's Email Address:
Mother's Email Address:
What Was Your Previous Dance Training / How Long & Where?
List Class Division:
Tuition Amount:
Annual Registration Fee:
Release Request & Hold Harmless Agreement:
I request permission for my child/myself, to participate in the classes at the Cassandra School of Ballet for the 2015-2016 school year. Parents agree to and understand that the teaching methods at Cassandra Ballet will often include "hands-on" instruction. Physical contact may be necessary to insure correct alignment and teaching technique for the students. I further request permission for my child or myself (if over 18 yrs. of age) to participate in performances, if eligible, during the aforementioned school year. I understand that in order for my child or myself to participate in the performance, my child/I must attend all rehearsals and be present at the mandatory dress rehearsals. I permit any photos of my child be used by Cassandra Ballet for media publicity purposes. In exchange for that permission, I for myself and/or my child and for our heirs and assigns do hereby release and agree to hold harmless the Cassandra School of Ballet and its directors, officers, employees, agents, successors and assigns from all claims and demands of any kind, including claims for injuries to person or property and defense costs and attorney’s fees, arising out of or related to, directly or indirectly, my child’s/my participation in the classes, rehearsals, performances and photography usage for the 2015-2016 school year. I am fully familiar with my child’s/own physical condition and limitations, and assume all risks of injury for my child/my person or property that my child/I may sustain in connection with participation in the 2015-2016 school year, rehearsals and performances.
I understand there are NO REFUNDS (tuition, performance fees/costumes)
for student suspension or voluntary withdrawal from the school program.
I have read and fully understand the terms of this Release Request and Hold Harmless Agreement.

You agree your electronic Signature is the legal equivalent of your manual signature for this Agreement. By signing this Agreement, you consent to be legally bound by the Agreement's terms and conditions.
Signature of Parent or Guardian:
Signature of Student (If Over 18 Yrs):
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