Online Student Registration 2024-2025

Online Student Registration 2024-2025

For all continuing students and new students who have already taken a placement class.
Student Name:*

First NameLast Name
Student Age:*
Birthdate:*

MonthDayYear
Date
Gender:*

MaleFemale
Parent Name (if student is under 18 years old):

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Best Contact Number*

Area CodePhone Number formatted xxx-xxxx
Is this a:*

Home PhoneCell PhoneWork Phone
Email Address:*
example@example.com
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Emergency Contact Relationship to Student*
Select the Current Quarter:*

Fall Quarter (September 5-November 4, 2023)Winter Quarter (November 6, 2023-January 14, 2024)Spring Quarter (January 15-March 30, 2024)Summer Quarter (April 1-June 8, 2024)
Classes:*
prevnext( X )
Kinderdance$125.00
Student Age 3/4

Please select Tuition Only or Tuition with the Class Leotard (Child or Adult) from the drop down menu:

Elementary$185.00
Student Age 5-6

Please select Tuition Only or Tuition with the Class Leotard (Child or Adult) from the drop down menu:

Basic 1$225.00

Please select Tuition Only or Tuition with the Class Leotard (Child or Adult) from the drop down menu:

Basic 2$250.00

Please select Tuition Only or Tuition with the Class Leotard (Child or Adult) from the drop down menu:

Intermediate 1$350.00

Please select Tuition Only or Tuition with the Class Leotard (Child or Adult) from the drop down menu:

Intermediate Advanced 1$400.00

Please select Tuition Only or Tuition with the Class Leotard (Child or Adult) form the dropdown menu:

Advanced$400.00

Please select Tuition Only or Tuition with the Class Leotard (Child or Adult) from the drop down menu:

Centre$500.00

Please select Tuition Only or Tuition with the Class Leotard (Child or Adult) from the drop down menu:

Adult Classes$150.00

Please select what Adult Class(es) you would like to sign up for:

Contemporary$130.00
*Pre-requesite: Completion of Intermediate 2 required to register for this class.

Total $0.00
Ballet Center Utah, Inc. Liability Agreement

I understand that my child will not be permitted to enroll in the next quarter if a balance is overdue for the previous quarter. The student will be asked to sit out until all tuitions are current.

No refunds will be given on tuition for any reason. All classes are paid and attended on a quarterly basis. Special arrangements can be made through our business office for installment payments at a slightly higher fee. All uncollected tuitions will be turned over to a collection agency.

A discount for more than one child in a family is available.

Students paying late will be charged a 10% service charge. Any unpaid balance will be turned over to a collection agency. This policy will be strictly enforced.

I, hereby authorize Ballet Center Utah, Inc., its agents, and/or employees to obtain treatment for my child and do not hold any employees or owners liable at Ballet Center Utah, Inc. for any injury or illness that he/she may suffer while attending classes conducted by Ballet Center Utah, Inc.
Agree to Terms of Liability*

By checking this box, you agree to the above set terms from Ballet Center Utah, Inc.
COVID-19 Agreement

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing and that Ballet Center Utah, Inc. has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.

I further acknowledge that Ballet Center Utah Inc. cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others.

I voluntarily seek services provided by Ballet Center Utah, Inc. and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending the Summer Ballet Study.

I attest that I/my student am/are not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell and am following all CDC recommended guidelines and guidelines set forth by Ballet Center Utah, Inc. as much as possible to limit my own/my student’s exposure to the Coronavirus/COVID-19.

I hereby release Ballet Center Utah, Inc. from any liability or claim that I and/or my student may have against the studio with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Ballet Center Utah, Inc. This liability waiver and release extends to the studio together with all owners, partners, and employees.
Agree to Terms of Regarding COVID-19*

By checking this box, you agree to the above statement regarding COVID-19.
Ballet Center Utah, Inc. Talent Release Form

This form grants Ballet Center Utah, Inc. the use of any photographs/video that have been or will be taken of me/my child during classes, performances or planned photo/video shoots during the school year, or in which I may be included with others.

I understand that these photographs/videos may be edited and used in whole or in part, individually or in conjunction with other photographs, in any medium for any purpose whatsoever, including (but not limited to) illustration, promotion and advertising as well as on Social Media platforms, such as Facebook and Instagram.

I hereby give permission to Ballet Center Utah, Inc., with respect to the photographs/video that have been taken of me/my child to:
1. copyright the same in his/her own name or any other name he/she may choose.
2. use, reuse publish and republish the same in whole or part, individually or in conjunction with other photographs, in any medium for any purpose whatsoever, including (but not by way of limitation) illustration, promotion and advertising.
3. to use my name in connection therewith if he/she so chooses.
I hearby release and discharge Ballet Center Utah, Inc. from any and all claims and demand arising out of or in connection with the use of the photographs/videos, including any and all claims of libel.

The authorization and release shall ensure to the benefit of the legal representatives, licensees and assigns of Ballet Center Utah, Inc. as well as the person(s) for whom he/she took the photographs.
Agree to Terms of Talent Release*

By checking this box, I give permission to Ballet Center Utah, Inc. to use photographs of myself/my child that are taken during classes, performances or planned photo/video shoots during the school year in promotions, advertising and on Social Media Platforms.I ask that myself/my child not be included in any photographs taken during classes, performances or planned photo/video shoots used for promotion, advertising or on Social Media.

Pay with Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

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