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Any known medical problems, allergies, or medications being taken:

Previous Dance Training ( School, Teacher, Style of Dance, Years of Training, Number of Classes a Week)

I am aware that dancing, and the exercises associated with it, place unusual stress on the body and carry with them the risk of physical injury. On behalf of my child and (or if over 18) myself, I assume the risk and agree that Coastal Ballet shall not be held liable in any way or circumstance for injuries sustained during attendance at the Coastal Ballet Academy or any of it or any of Coastal Ballet's related functions. I grant my child or ward permission to participate in the Coastal Ballet Academy and/ or it's affiliate Coastal Ballet Company.  I hereby release and discharge Coastal Ballet Academy, Coastal Ballet Company, it's agents, employees, and others associated with Coastal Ballet from all claims, demands, actions, judgments, and executions to which the undersigned heirs, executors, administrators, or assigns may have or claim to have against Coastal Ballet, it's successors, or assigns, for all personal injuries caused by, or arising from, the above described activities or any activities related thereto. Furthermore, I grant Coastal Ballet, Coastal Ballet Academy, it's agents and employees, permission to authorize any emergency medical treatment that may be required for my child or ward, during the school session and to contact a local hospital and/or doctor if needed.

As a representative of Coastal Ballet Academy and it's affiliate Coastal Ballet Company, I agree to abide by the rules and regulations of Coastal Ballet.

I, the undersigned, have read this release/authorization and understand and agree to all of it's terms

I hereby give permission for the Coastal Ballet Company and/or Coastal Ballet Academy to use photographs or videos of my likeness in Coastal Ballet Company and/or Coastal Ballet Academy sponsored publications and for promotional purposes.

Please bring the completed Registration Form and $25 Registration Fee plus Tuition to the Academy or mail to: 


Coastal Ballet Academy

P.O. Box 11

Foley, AL 36536

Thanks for submitting!

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