VITACCA BALLET Division D Registration

DIVISION D
Registration Form 2026-2027
Classes Begin August 24 through May 15
Tentative Soiree: May 26-28
Contact: 713.205.0355 | VitaccaDance.com | houstonadmin@VitaccaDance.com
Address: 2821 W 11th St.
STUDENT'S NAME:

First NameLast Name
Street Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
City:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
BirthDate

MonthDayYear
Date
AGE:
School:
Grade:
Home Phone
Format: (000) 000-0000.
Cell Phone:
Format: (000) 000-0000.
Gender
Training Experience:
PARENT/GUARDIAN Responsible for Payments:
Mother's Full Name:

First NameLast Name
Mobile Phone:
Format: (000) 000-0000.
Email
example@example.com
Father's Full Name:

First NameLast Name
Mobile Phone:
Format: (000) 000-0000.
Email
example@example.com
EMERGENCY CONTACT
Name:
Relationship:
Emergency Phone #:
Format: (000) 000-0000.

AGREEMENTS AND RELEASE
Please initial to notate acknowledgement and agreement.
Vitacca Ballet & School for Dance, Houston children's classes are open for viewing. Our school is a focused training environment, thus we kindly ask parents to not overcrowd the school's waiting areas and stay mindful of noise levels within common areas.
Vitacca Ballet & School for Dance, Houston students wishing to participate in Vitacca performances may not take ballet, contemporary or modern lessons at other studios/schools.
Vitacca Ballet & School for Dance, Houston students may not participate in performances for another studio in which the student is performing Ballet, Contemporary or Modern.
All tuition and fees are non-refundable (includes paid full year tuition, and all other fees). (In the case of serious illness or injury, exceptions may be made at the discretion of the School.)
Withdrawal from the School must be made in writing 30 days prior to the last lesson attended. Tuition will be charged until 30 days after the written notice is received. (This does not apply to discounted pre-paid tuition. There are no refunds.)
Division training costs (tuition) is based on a 34-week season and divided into ten payments from time of registration through April 2027. Month to month registration is not allowed.
Covid-19 Release Statement- Vitacca Ballet & School for Dance (Vitacca Dance) has put in place heightened cleaning measures to reduce the spread of Covid-19. However, Covid-19 has been proven to be highly contagious and asymptomatic in some persons. Therefore, Vitacca Dance cannot guarantee that you or your child(ren) will not become infected with Covid-19. Further, attending Vitacca Dance could increase your risk and your child(ren)'s risk of contracting Covid-19. By initialing, you acknowledge the contagious nature of Covid-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by Covid-19 by attending Vitacca School for Dance and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand as of June 20, 2021, masks will be optional at Vitacca Ballet & School for Dance.
Participation Release Agreement
In consideration for receiving permission to participate in this class, performance, rehearsal, or any and all activities related thereto, including but not limited to travel between sites or locations ("Activities"), I hereby release, indemnify, and covenant not to sue Kelly Ann Vitacca, Vitacca Vocational School for Dance, Houston, and any associates or employees thereof ('Releasees"), for any and all claims, costs and causes of action for property damage or personal injury, sustained by me while participating in Activities, whether arising from statute, code, ordinance, tort, common law or other source.
I acknowledge that Activities I will perform may be physically strenuous. I know of no physical or mental condition, which would preclude or inhibit my full participation in Activities. I am fully aware of the risks and hazards involved with Activities, including but not limited to slips, trips, falls, breaks, heat stroke, heart attack, exhaustion, dehydration, and other related injuries. I choose to voluntarily participate in Activities with full knowledge that they may be hazardous to my property and me.
I understand that Releasees do not maintain any insurance policy covering any circumstance arising from my participation in Activities or any event related to that participation. I am aware and understand that I should obtain and review my personal insurance coverage. In signing this release, I acknowledge that I have read and understood the Release, that I am at least eighteen (18) years of age or my guardian is at least eighteen (18) years of age and fully competent.
Photo | Video | Release Agreement
In consideration of good and valuable considerations, the receipt of which is hereby acknowledged, I hereby grant to Vitacca Ballet & School for Dance, Houston, its nominees, designees, successors and assigns, or those for whom they are acting, the absolute right and permission to copyright, and/or use, and/or publish photographs/videos of my dancer in class or at performances, or in which I may be included in whole or in part, or composite, or distorted in character or form, in conjunction with my own or any other picture/video or reproductions thereof made at its studios or elsewhere, for art, advertising, business or trade, news reporting, social media, website, or any other lawful purpose
Signature
Date

MonthDayYear
Date
Health Information
Please list any allergies:
Please list additional health information if necessary:
I hereby give my permission to Vitacca Ballet & School for Dance personnel to authorize any minor emergency medical treatment that may be required during Vitacca Ballet & School for Dance program including: Intensives, Dance Class, Invite Class, Open Class, Rehearsals, Master Classes and Performances. I understand that I am responsible for all charges because of such care and medical treatment.
Name of Participant, Parent or Guardian:
Signature
Date:

MonthDayYear
Date

Payment Information
- I acknowledge that all tuition and fees are non-refundable.
- I understand that make-up classes are based on availability.
- I agree to keep a credit card on file for my dancer to participate.
- Following the completion of this form and initial installment, I will receive a Credit Card Authorization form and an invoice detailing the recurring installment plan via a separate email.
INITIAL HERE

TUITION INFORMATION:

OPTION A

Installment Amount: $5,674 (mandatory classes only)
*Select a mandatory extended training class below.
Add Contemporary $727
Add Conditioning $582
Add Adv. Modern $1212

OPTION B

Installment Amount: $585.00 (mandatory 4 ballet)
*Select a mandatory extended training class below.
Add Contemporary $75
Add Conditioning $60
Add Adv. Modern $125

Class Tuition + Payment Options:

Tuition is divided into 10 installments. Installments are provided for your convenience. You are committing to the Aug-May training program with the option to withdraw with a paid 30-day notice. Tuition is due on the 15th of each preceding month and is considered late on the 16th.
I understand that tuition payments are due by the 15th of each preceding month. I understand registration is only available through a one-time registration installment followed by auto-draft payments thereafter.
Signature:
Date:

MonthDayYear
Date

Registration and Payment

Regisration Fee

$75 Quantity
Item subtotal:

Division D Monthly Tuition

$585 Quantity
Item subtotal:

Contemporary

$75 Quantity
Item subtotal:

Adv. Modern

$125 Quantity
Item subtotal:

Conditioning

May add 2 for twice/week

$60 Quantity
Item subtotal:

Total

Credit Card

Should be Empty:

DIVISION DRegistration Form 2026-2027Classes Begin August 24 through May 15Tentative Soiree: May 26-28Contact: 713.205.0355 | VitaccaDance.com | houstonadmin@VitaccaDance.comAddress: 2821 W 11th St.

PARENT/GUARDIAN Responsible for Payments:

EMERGENCY CONTACT

AGREEMENTS AND RELEASE

Participation Release Agreement

Photo | Video | Release Agreement

Health Information

Payment Information

I acknowledge that all tuition and fees are non-refundable.

I understand that make-up classes are based on availability.

I agree to keep a credit card on file for my dancer to participate.

Following the completion of this form and initial installment, I will receive a Credit Card Authorization form and an invoice detailing the recurring installment plan via a separate email.

TUITION INFORMATION:

Class Tuition + Payment Options:

Class Selection:

Registration and Payment*

Credit Card

DIVISION D
Registration Form 2026-2027
Classes Begin August 24 through May 15
Tentative Soiree: May 26-28
Contact: 713.205.0355 | VitaccaDance.com | houstonadmin@VitaccaDance.com
Address: 2821 W 11th St.

Registration and Payment