Holiday Intensive Enrolment Form

Holiday Intensive Enrolment Form

Student Details
Student Name*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Date
Student age:*
Medical Conditions/Allergies*
Contact Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Week Attending
Name of current Ballet School/Academy*
Director's Name*

First NameLast Name
Ballet School/Academy Email*
example@example.com
Are you an aspiring professional ballet dancer?*

YESNO (I do ballet recreationally)

Student Medical Information
Allergies*
Medical Conditions*
Current Medications*
Additional Information
Does the student have any special needs or accommodations?*
(if YES, please list)
Is there any additional information that we should know?*
CONSENT AND RELEASE

I hereby authorize the staff of Ballet Express to act on my behalf in case of an emergency involving the student listed above. I understand that every effort will be made to contact me or the emergency contact listed above, but in the event that neither I nor the emergency contact can be reached, I give my consent for Ballet Express staff to seek emergency medical treatment for the student. I release Ballet Express and its staff from any liability in connection with the treatment of the student in case of an emergency.
Parent/Guardian Signature:*

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Date signed*

DayMonthYear
Date

Holiday Intensive 2026*

AUDWeek 1 (12 - 16 Jan) = $250 Week 2 (19 - 23 Jan) = $250 BOTH Weeks = $450

Parent/Guardians Information