Feijoo Ballet School 2022 Summer Intensive

Photo Credits: Rhonda Floyd Photography & Ashkan Images
SUMMER INTENSIVE 2023 REGISTRATION FORM
Student's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary number*

Area CodePhone Number
Alternate number*

Area CodePhone Number
Student's E-mail*
Parent/Guardian E-mail*

Consent and Liability Waiver
Required*

I grant permission for my child to participate in Feijoo Ballet School's Summer Intensive 2023.
Required*

I agree on behalf of myself, my child’s other parent, if known or living, that my child name herein, or our heirs, successors, and assignees are to hold harmless from ALL liability now and in the future Feijóo Ballet School, its faculty and staff and all parts involved as a result of our voluntary participation and enrollment
COVID 19 WAIVER Required*

I understand that an inherent risk of exposure to the Novel Coronavirus / Covid 19 exists in any public place where people are present. I understand that COVID 19 is a highly contagious disease that may result in personal injury, illness, permanent disability, and death. By visiting Feijoo Ballet School and/or allowing my children to participate in the Program, I voluntarily assume the risk that my child and I may be exposed to or infected by COVID 19. I understand that the risk of becoming exposed to or infected by COVID 19 at Feijoo Ballet School may result from the actions, omission, or negligence or myself and others, including, but not limited to Feijoo Ballet School, its employees, faculty and staff and program participants and their families.
COVID 19 WAIVER Required*

Feijoo Ballet School has implemented preventative protocols and measures based on recommendations from the Center for Disease Control and Prevention (CDC) to reduce the spread of Covid 19, including but not limited to class sizes, hand washing, regular disinfection of surfaces, and temperature screening. All visitors MUST follow Feijoo Ballet School's health and safety protocols. However, I understand that Feijoo Ballet School cannot guarantee that I or my child will not become infected with COVID 19. Furthermore, I understand that participating in the Summer Intensive could increase my risk and my child's risk of contracting COVID 19.
COVID 19 WAIVER Required*

I voluntarily agree to assume all of the forgoing risks and accept sole responsibility for any injury to my child or myself. I hereby release, covenant not to sue, discharge and hold liabilities, claims, actions, damages, costs or expenses of any kind arising out of any Claim or relating thereto to Feijoo Ballet School whether a COVID 19 infection occurs before, during or after participation in the Summer Intensive.
Parent: In signing this form I certify that all information contained herein is true and accurate to the best of my knowledge.
Parent type full name to sign.*
Student: In signing the line below, I agree to abide by any/all policies and rules established for this event/activity. Should I not be able to maintain the guidelines and expectations of the adults and my peers, I understand that there will be consequences for my actions, including being removed from the activity and being sent home at my parent’s expense.
Student's Full Name*

VIDEO/PHOTOGRAPHY CONSENT
As parent/guardian, I understand that promotional pictures and videos (individual and group) will be taken during this event.
Check one.*

I give permission for my son’s/daughter’s picture to be used for promotional materials (newsletter, web page, social media, calendars, PowerPoint, video, etc.) in highlighting the event.I DO NOT give permission for my son’s/daughter’s picture to be used for promotional materials (newsletter, web page, social media, calendars, PowerPoint, video, etc.) in highlighting the event.

INSURANCE INFORMATION
Check one.*

No, my child does not have medical insurance at this time.Yes, my child has insurance and below is the information.
Insurance Carrier
Name of Insured
Insurance Policy #
Father's Name

First NameLast Name
Father's Number

Area CodePhone Number
Mother's Name

First NameLast Name
Mother's Number

Area CodePhone Number
In the event it comes to the attention of the staff associated with the activity that my child becomes ill with repeated symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called immediately. If this will be a long distance call, I want to be called collect (with phone charges reversed to myself). I fully understand the foregoing statements and sign this Parental/Guardian Medical Consent Waiver knowingly, freely, and willingly.

Please sign one of the following below.
Signature (Parent/Guardian must sign for anyone under 18 years of age.)
Signature (Student 18 years of age or older)

Summer Intensive 2023
My child will be attending: *

Week 1: June 5 - 9 (Fee $715.00)Week 2: June 12 - 16 (Fee $715.00)Week 3: June 19 - 23 (Fee $715.00)Week 4: June 26 - 30 (Fee $715.00)

PAYMENT

Once the dancer is registered, a statement will be sent with a balance based on the number of selected weeks. Payment is due upon receipt of Statement. All payments must be completed before a dancers is admitted to class.
REFUND POLICY

Summer Intensive Fees are non-refundable and non-transferable. If a participant must miss class due to sickness or quarantine at any point of the Summer Intensive Program, the participant will be given virtual content to supplement in-studio classes and will not receive a tuition refund.
Feijoo Ballet School reserves the right to change or amend any of these policies or guidelines on the evolving nature of information and readily available testing for COVID 19.
Make your selection(s):
prevnext( X )
Deposit (non-refundable) & non-tranferable$50.00

Total $0.00
Should be Empty:

Photo Credits: Rhonda Floyd Photography & Ashkan Images

SUMMER INTENSIVE 2023 REGISTRATION FORM

Consent and Liability Waiver

VIDEO/PHOTOGRAPHY CONSENT

MEDICAL CONSENT FORM

INSURANCE INFORMATION

Summer Intensive 2023

PAYMENT

REFUND POLICY