Ballet Reign Academy

Trial Class Request Form

Parent/Guardian Name

For students 21 yrs and under

First Name

Last Name

Student Name

First Name

Last Name

Student Date of Birth

YYYY

Student Current Age

Student Gender

Male

Female

Phone

(###)

###

####

Primary Interest

Select all that apply

Ballet

Contemporary

Jazz

Tap

Other

Previous/Current Dance School

Years of Dance Training

Hours of Dance Training per Week

Years of Pointe Work

If not applicable, please specify

Message

Please tell us about your goals, previous dance experience, and how we can help

How did you hear about Ballet Reign?