Mississauga Ballet Association
Classes held at the Living Arts Centre
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Mississauga Ballet Association Waiver 2021-2022
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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
CBI2122S
CBII2122F
CBIII2122F
CBIV2122S
CBV2122T
CBVII2122T
CBVIII2122T
KD2122S
PBII2122S
PBII2122TH
SR2122TH
SRB2122TH
2nd Choice
Second Choice
CBI2122S
CBII2122F
CBIII2122F
CBIV2122S
CBV2122T
CBVII2122T
CBVIII2122T
KD2122S
PBII2122S
PBII2122TH
SR2122TH
SRB2122TH
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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I have read and agree to the
terms in the waiver
.
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Do not enter anything here!
