Open Division Enrollment/Registration Form 2024/25

Training Center Enrollment Form

2024/25 School Year
Student Name*

First NameMiddle NameLast Name
Student Age*
Student Birth Date*

MonthDayYear
Which classes you would like to register for?*

Beginner Ballet, Thurs 5-6pm (ages 9-12)
Price Breakdown:

1 class/week - $85 monthly
Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Contact Information

Most correspondence will be done via the Email, however please provide at least one phone number for necessary situations.
Parent E-mail*
example@example.com
Student E-mail (if desired)
example@example.com
Parent/Guardian 1 Name*

First NameLast Name
Parent/Guardian 1 Primary 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. *

Clear
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. *

Clear

How would you like to pay your tuition for the year?*

Monthly - Due on the 15th of each month

My Products

Registration FeeDue June 15, 2023

$50.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

Training Center Enrollment Form

Parent/Guardian Contact Information

Medical Information Form

Insurance Information

Medical History/Information

Medications

Consent to Medical Treatment

Liability Waiver

Photograph/Video Release Authorization