Registration Form For Open Classes Date Name Address Home Phone Cell or Other Email Address Date of Birth Place of Employment Work Phone   Does your company have a matching gift program? Yes No   Emergency Contact Phone Number Physician Phone Number     Medical conditions, allergies or special needs:     Previous ballet training (optional):     Special skills and interests:     Referred to Western Ballet by:     Would you be interested in helping in Western Ballet's productions? Yes No   READ WAIVER All students must read the waiver before submitting an application. By submitting this form (Clicking on SUBMIT) you are stating that you have read and are in agreement with the waiver.