First come first served registrations beginning April 7 with accompanying registration ($30) payment CHECK or MONEY ORDER

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Name

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Address

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City State Zip

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Parent Name (if minor)

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home phone/ work phone

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email if any

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student date of Birth

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requested week - July 14-18 ($160.00)

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requested week - July 21-25 ($160.00)

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both weeks July 14-25 ($280.00)

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Payment rendered check#

Please send payment of non-refundable $30 registration fee to: Lafayette Ballet Registration, 628 Main Street, Lafayette, IN 47901. We will contact any registrants whose first choice of classes cannot be granted. Registration will be applied toward semester tuition. Please feel free to call the school at 765.423.1633 between 4:30 and 7:30 PM to speak with the secretary. Please keep your account current. We are not structured to send individual billing to students.