BALLET SCHOOL - REGISTRATION FORM
Myra Mier School of Ballet Registration Form Student Information, required fields marked with a * *Student's Name: Birth Date (mm/dd/yy) Current Age Home Phone (include area code) Cell Phone (include area code) Emergency Contact Name Emergency Contact Number *Mailing Address: *City: State (US): Other Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming *Zipcode: *Email Past Ballet Training: Years Studio Father's Name Occupation/Place of Employment Mother's Name Occupation/Place of Employment If you would like further information please call (504) 468-1231. A non refundable registration fee of $35.00 will hold a student's place in the class. You will be contacted with a schedule of class times in August. Myra Mier School of Ballet 3621 Florida Avenue Kenner, Louisiana 70065 (504) 468-1231
Myra Mier School of Ballet Registration Form
Home Phone (include area code)
Cell Phone (include area code)
Emergency Contact Name
Emergency Contact Number
If you would like further information please call (504) 468-1231. A non refundable registration fee of $35.00 will hold a student's place in the class. You will be contacted with a schedule of class times in August.
Myra Mier School of Ballet 3621 Florida Avenue Kenner, Louisiana 70065 (504) 468-1231
