Summer 2023 Pre-Primary 6-Week Session

Pre-Primary Summer 6-Week Session

June 21- July 26

Wednesday's 9:00-9:45am

$75 for session
Student Name*

First NameMiddle NameLast Name
Student Age*
Date of Birth*

MonthDayYear
Date
Parent/ Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Payment Portal

To complete registration please provide payment information below. Tuition will be due August 1st.

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TuitionTuition for 6 weeks of classes

$75.00

Total

$0.00

Parent/Guardian Contact Information

Most correspondence will be done via Email, however please provide at least one phone number for necessary situations. You will be given a link to join your classes Band once you have completed enrollment.
Parent E-mail*
example@example.com
Parent/Guardian Name*

First NameLast Name
Parent/Guardian 1 Primary Phone Number*
Please enter a valid phone number.
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian 2 Primary Phone Number
Please enter a valid phone number.
Emergency Contact Information

If a parent cannot be reached in the event of any emergency, the following person should be contacted.
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.

Consent to Medical Treatment

In an emergency, when parental permission is not available, I hereby give my permission for a Florida Ballet staff member to consent to medical treatment for our child and/or ward.
In an emergency, when parental permission is not available, I hereby give my permission for a Florida Ballet staff member to consent to medical treatment for our child and/or ward. *

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Liability Waiver
I am aware that dance and the nature of the training and performing associated with The Florida Ballet place unusual stress on the body and carry with them the risk of physical injury. On behalf of my child and myself, I assume the risk and agree that Florida Ballet at Jacksonville, Inc., the Training Center and the staff of this institution shall not be liable in any way for injuries sustained during attendance in classes, rehearsals, or related functions.

It is also understood that dance instruction involves kinetic corrections that may include physically touching a student as part of regular class work and rehearsals. Parents or students with any concerns should speak with their instructors before class.
I certify that I have read and fully understand this liability waiver and that all questions pertaining to this consent have been answered to my satisfaction.*

Clear

Photograph/Video Release Authorization
I, the undersigned, give permission to the Florida Ballet, and/or parties designated by The Florida Ballet to photograph/video me or the minor named below and use such photograph(s)/video(s) in all forms of media, for any and all promotional purposes including advertising, display, audiovisual, exhibition or editorial use.

I further consent to the use of my name or the minor’s name listed below in connection with the photograph(s)/video(s) if needed by The Florida Ballet and/or parties designated by The Florida Ballet.

I understand and agree that I or the minor listed below will not receive any payment for time, expenses or any royalty for the publication of the photograph(s)/video(s) or the use of my/minor’s name and I hereby release The Florida Ballet and/or any parties designated by The Florida Ballet from any such claims.
I certify that I have read and fully understand this consent and release, and that all questions pertaining to this consent have been answered to my satisfaction. *

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Name of Student (as you wish it to appear in press and programs)*
Should be Empty:

Payment Portal