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Child's Name * First Last
Age & DOB
Parent or Guardian * First Last
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Phone Number ### - ### - ####
Allergies & Medical Concerns
Person(s) authorized to Pick up student
Kinderballet (Ages 3-5)
Monday 3:45-4:45 PM
Tuesday 3:45-4:45 PM
Wednesday 2:45-3:45PM - Closed

Pre-Ballet (Ages 4 1/2-5)
Wednesday 3:45-4:45 PM

Ballet I (Ages 5-7)
Tuesday 4:45- 5:45 PM
Wednesday 4:45- 5:45 PM (Beginners Preferred Class)

Advanced Ballet I (Ages 6-8)
Thursday 3:45-4:45 PM

Ballet II (Ages 8-12)
Monday 4:45-5:45 PM
Thursday 4:45-5:45 PM

Monday KB 3:45-4:45 PM Tuesday KB 3:45-4:45 PM Wednesday Pre-B 3:45-4:45 PM Tuesday B1 4:45- 5:45 PM Wednesday B1 4:45- 5:45 PM (Beginners Preferred Class) Thursday Advanced B1 3:45-4:45 PM Monday B2 4:45-5:45 PM Thursday B2 4:45-5:45 PM
Form of Payment *
Paypal (Registration Page) Check (Payable to MLYNA, PO BOX 3081, Alexandria, VA 22302)

Monthly payments due first week of each month to avoid $5 LATE Fee. Tuition is NOT refundable unless MLYNA cancels a class for the term. Make up classes are offered if that week's classes are canceled.
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