FEIJOO FINE ARTS Registration Form

FEIJOO FINE ARTS - FALL 2024

Registration Form for NON-FBS Students
CLASS SCHEDULE

Classes Begin on Tuesday, October 1 & Wednesday, October 2

MORNING CLASSES - WEDNESDAYS

Students ages 4 - 10:

Wednesdays from 11:15AM to 12:00PM (45 minutes)

Fee: $275 (Includes supplies)

Note: 1/2 cost of the class $137.50 due at registration. Second 1/2 of the class $137.50 due on November 5. (Non-Refundable and Non-Transfereable).

Students ages 11 and up:

Wednesdays from 10:00AM to 11:00AM (1 hour)

Fee: $300 (Includes supplies)

Note: 1/2 cost of the class $150 due at registration. Second 1/2 of the class $150 due on November 5. (Non-Refundable and Non-Transfereable).

AFTERNOON CLASSES - TUESDAYS AND WEDNESDAYS

Students ages 4 - 7:

Wednesdays from 5:45PM to 6:30PM (45 minutes)

Fee: $275 (Includes supplies)

Note: 1/2 cost of the class $137.50 due at registration. Second 1/2 of the class $137.50 due on November 5. (Non-Refundable and Non-Transfereable).

Students ages 6 - 12:

Tuesdays from 4:30PM to 5:15PM (45 minutes)

Fee: $275 (Includes supplies)

Note: 1/2 cost of the class $137.50 due at registration. Second 1/2 of the class $137.50 due on November 5. (Non-Refundable and Non-Transfereable).

Students ages 11 and up:

Tuesdays from 5:45PM to 6:45PM (1 hour)

Fee: $300 (Includes supplies)

Note: 1/2 cost of the class $150 due at registration. Second 1/2 of the class $150 due on November 5. (Non-Refundable and Non-Transfereable).

*** Registration Fee for Non-Feijoo students: $25.00
Student's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age*
Gender*
Parent/Guardian Name*

First NameLast Name
Primary number*

Area CodePhone Number
Alternate number*

Area CodePhone Number
Parent/Guardian E-mail*
Consent and Liability Waiver
Important! To be filled out by the Parent/Guardian for youth under 18 years of age.
Required*

I grant permission for my child to participate in the Feijoo Ballet School - Fall 2024 Fine Arts Class
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 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.
Parent: In signing this form I certify that all information contained herein is true and accurate to the best of my knowledge.
Type 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.
MEDICAL CONSENT FORM

All Medical Information is kept strictly confidential.
Medical Matters

I hereby warrant to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child.

Emergency Medical Treatment

In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor and I understand that all financial obligations are my responsibility.

In the event of an emergency and you are unable to reach me, contact:
Name of Contact*
Relationship of contact to student*
Phone Number*

Area CodePhone Number
Family Doctor*
Phone Number*

Area CodePhone Number
Medications

My child will bring all such medications, well labeled, that are necessary. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency are as follows:

My child is taking the following medication at the present time:
Medication(s)
Dosage
Administer times
Medical Conditions Information: (Personnel will take reasonable care to see that the following information will be held confidential.)

My son/daughter:
Had an episode of the following or has been diagnosed:

SeizuresAsthmaDiabetic
Allergic reactions to the following (foods, dyes, medications, latex, etc.)
Had medical surgery within the last six months?

YesNo
Still under a doctor's care?

YesNo
Has a medically prescribed diet?
The following physical limitations:
Immunizations current and up to date?

YesNo
Date of last tetanus/diphtheria immunization (month/year)
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 below.
Signature (Parent/Guardian must sign for anyone under 18 years of age.)*
PAYMENT
Class Selection:*
prevnext( X )
MORNING CLASSES FOR AGES 4 TO 10 (Semester Fee $275)$162.50
Registration Fee $25 + 1/2 cost of the class $137.50 Second 1/2 of the class $137.50 due on November 5. (Non-Refundable and Non-Transfereable).

MORNING CLASSES FOR AGES 11 & UP (Semester Fee $300.00)$175.00
Registration Fee $25 + 1/2 cost of the class $150.00 Second 1/2 of the class $150.00 due on November 5. (Non-Refundable and Non-Transfereable).

AFTERNOON CLASSES FOR AGES 4 TO 7 (Semester Fee $275) $162.50
Registration Fee $25 + 1/2 cost of the class $137.50 Second 1/2 of the class $137.50 due on November 5. (Non-Refundable and Non-Transfereable).

AFTERNOON CLASSES FOR AGES 6 TO 12 (Semester Fee $275.00) $162.50
Registration Fee $25 + 1/2 cost of the class $37.50 Second 1/2 of the class $137.50 due on November 5. (Non-Refundable and Non-Transfereable).

AFTERNOON CLASSES FOR AGES 11 & UP (Semester Fee $300.00) $175.00
Registration Fee $25 + 1/2 cost of the class $150.00 Second 1/2 of the class $150.00 due on November 5. (Non-Refundable and Non-Transfereable).

Total $0.00
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FEIJOO FINE ARTS - FALL 2024

Consent and Liability Waiver

VIDEO/PHOTOGRAPHY CONSENT

MEDICAL CONSENT FORM

INSURANCE INFORMATION

PAYMENT