Language
English (US)
French (France)
SUMMER WORKSHOP - 2022
REGISTRATION
Student
Student. Name
*
First Name
Last Name
Gendre
*
Male
Female
Other
Prefer not say
Birthdate
*
-
Month
-
Day
Year
Date
Dates Difference
Student Email
*
example@example.com
MEDIA RELEASE From time to time, photographers or film crews will be present photographing or filming French Academie of Ballet classes and rehearsals. Permission for resulting photographs and film footage that include either students or students’ guardians is assumed to be granted in perpetuity by them for purposes on television, magazines, or any other media.
*
I agree
HOUSEHOLD
Household
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian 1
*
First Name
Last Name
Relationship to Student
*
Cell Phone
*
-
Area Code
Phone Number
Home Phone
*
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Email Address
*
example@example.com
Emergency Contact
*
Yes
No
Parent/Guardian 2
*
First Name
Last Name
Relation to Student
*
Cell Phone
*
-
Area Code
Phone Number
Home Phone
*
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Email Address
*
example@example.com
Emergency Contact
*
Yes
No
CONTACT Other Than Parent/Guardian
Rows
Name
Relationship
Emergency
Phone
Email
Street
City
ZipCode
.
.
.
.
.
HEALTH
Medical Insurance Company
*
Group or Policy Number
*
Physician or Clinic
*
Physician Phone Number
*
-
Area Code
Phone Number
Dentist
*
Dentists Phone
*
-
Area Code
Phone Number
Preferred Hospital
Medical Condition
*
Allergies
*
Medications
*
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Waivers
As a participant in any program or class of the French Academie of Ballet and any spaces used by the French Academie of Ballet, I recognize and acknowledge certain physical injury risks. I agree to assume the entire risk of injuries, including death, damages, or loss that my minor child or I may sustain due to participating in any activities connected with or associated with such program or class. I agree to waive and relinquish all claims my minor child or I may have due to participating in any program or class against the French Academie of Ballet and its officers, agents, servants, employees, and independent contractors. I further agree to indemnify and hold harmless and defend the French Academie of Ballet and its officers, agents, servants, employees, and independent contractors from my claims resulting from injuries including death, damages, and losses sustained by me or my minor child that arise out of, in connection with, or in any way associated with the activities of this program.
*
I Accept The Terms And Conditions
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Financial Responsability
Household Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian 1 Financial Responsibility
*
First Name
Last Name
*
Yes
No
Parent/Guardian 2 Financial Responsibility
*
First Name
Last Name
*
Yes
No
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Consent Text
I understand that to participate in Summer 2022, I must be vaccinated, provide a copy of my vaccination record, and know that I may only attend when I am fully enrolled. To be considered fully enrolled, I must complete the Registration (tuition payment) and the enrollment form and return it by August 5th, 2022. I understand that the tuition is non-refundable once the program has started. If I withdraw two weeks before the start of the program, I will get refunded only fifty percent of the tuition minus the administrative fee ($25). If I withdraw one week before the start of the program, I will get refunded only twenty-five percent of the tuition minus the administrative fee ($25)
*
I Accept the rules
Parent/Guardian 2 Signature
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Please upload a headshot and picture in first arabesque
*
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