Summer 2023 Beginner Ballet 6-Week Session

Beginner Ballet Summer 6-Week Session

June 21- July 26

Wednesday's 5:00-6:30pm

Ages 8+

$125 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

$125.00

Total

$0.00

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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.*

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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)*

Waiver of Liability Relating to Coronavirus/COVID 19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life-threatening illness and even death.

The Florida Ballet cannot prevent you [or your child(ren)] from becoming exposed to, contracting, or spreading COVID-19 while utilizing The Florida Ballet’s services or premises. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize The Florida Ballet’s services and/or enter onto The Florida Ballet’s premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.

ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children to utilize The Florida Ballet’s services and enter The Florida Ballet’s premises. These services are of such value to me [and/or to my children,] that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize The Florida Ballet’s services and premises in person.

WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against The Florida Ballet and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing The Florida Ballet’s services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.

CHOICE OF LAW: I understand and agree that the law of the State of Florida will apply to this contract.
By signing below I, First Name*First Name* Last Name* as the parent/legal guardian of minor,
First Name* Last Name* hereby consent that I have carefully read and fully understand all provisions of this release, and freely and knowingly assume the risk and waive my rights concerning liability as described above.
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Parent Signature*

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Payment Portal

Parent/Guardian Contact Information

Emergency Contact Information

Medical Information Form

Insurance Information

Medical History/Information

Medications

Consent to Medical Treatment

Liability Waiver

Photograph/Video Release Authorization

Waiver of Liability Relating to Coronavirus/COVID 19