Mississauga Ballet Association
Classes held at the Living Arts Centre
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Mississauga Ballet Association
Registration From 2021/2022
Student Info
First Name
*
Last Name
*
Email
*
Address
*
City
*
Province
*
Postal Code
*
Home Phone
*
Birthdate
*
Age as of Sept 2021
Years of dance training
Are you a returning dancer?
No
Yes
Class Code that Miss Eilleen gave you
1st Choice
*
Please Select
CB82021TH60
CBI2021M45
CBII2021F60
CBIII2021S60
CBIV2021T60
CBV2021S60
CBVI2021T60
JRC2021T60
KD2021F30
KD2021M30
PBI2021M45
PBI2021S45
PBII2021S45
PBII2021TH45
PNT2021TH45
SR2021TH90
SRB2021F60
SRC2021T60
2nd Choice
Second Choice
CB82021TH60
CBI2021M45
CBII2021F60
CBIII2021S60
CBIV2021T60
CBV2021S60
CBVI2021T60
JRC2021T60
KD2021F30
KD2021M30
PBI2021M45
PBI2021S45
PBII2021S45
PBII2021TH45
PNT2021TH45
SR2021TH90
SRB2021F60
SRC2021T60
Parent Info
Parent's First Name
*
Parent's Last Name
*
Mother or Father?
Mother
Father
Same address as student?
Address (if different)
City
Postal Code
Home Phone
Work Phone
Cell Phone
Email
Emergency Contact
Name
*
Phone
*
Allergies/Health Problems
Who will pickup the dancer?
Pickup Name
*
Pickup relationship to dancer
*
Sisters/Brothers in the MBA
Name
Class Level
Name
Class Level
I would like to add a donation
$25
$50
How did you hear about MBA?
Internet
Family/Friend
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terms in the waiver
.
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Do not enter anything here!