Luzicka Ballet's 2021 Summer Ballet Camp Intensive Enrollment Form

Please fill complete ALL fields below to ensure we have current information for all students!


Student first name

Student last name

Student DOB:

Parent/Guardian name

Parent/Guardian name



Please select a camp:


Will you be using the credit card we have on file (current student),
or do you need to provide a new credit card (new/current student)?

Primary mobile number:

Secondary mobile number:

Student's mobile number (if any):

Primary Email:

Secondary Email:

Student Email (if any):

Address:



How did you hear about us?






Additional information:

Previous training? Allergies? Special need we need to be aware of?
Let us know!





Luzicka Ballet may take photos during classes or activities for promotional purposes only. Do you give us consent to use your child's image in promotional materials?



Liability policy.
All athletic activities, including Classical Ballet, have a risk of injury if done improperly. One of Luzicka Ballet's primary focuses in our instruction is injury prevention.
With proper training and preparation the risk of injury is greatly reduced, however, injuries are always possible, and Luzicka Ballet cannot be held responsible for those injuries.


By clicking "Agree and Submit" you acknowledge you have read and agree to these policies.