Moscow Ballet
Child name:_______________________________________________ Age:___
Address:_______________________________________________________
City:__________________________________ State:____ Zip:____________
Phone:_____________________ Height:_____ Dress Size:____ Pant Size:_____
Parent/Guardian Name:____________________________________________
Parent/Guardian Address (if different from above):________________________
City:___________________________________ State:_____ Zip:__________
Parent/Guardian Phone: (day)________________ (evening)________________
Dance School:______________________________ Phone:_________________
Dance Teacher Name:__________________________ Years studying dance:____
Academic School Name:_____________________________________________
Principal's Name:__________________________ Phone:__________________
How did you hear about us?__________________________________________
What is your favorite community newspaper?_____________________________
I, as parent/guardian, give my permission for the above registered child to participate, if selected, in Moscow Ballet's "Great Russian Nutcracker." I will see that my child attends the required weekly rehearsals. I also authorize my child's name to be listed as a cast member in performance program and on Moscow Ballet's website (www. nutcracker. com).
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Signature
__________________________________________________________
Print Name
______________________
Relationship to child
______________________
Date
Please Print Legibly. This Is How Your Child's Name Will Appear In Moscow Ballet's Program.