• Evaluation and Placement Class

    Lois Ellyn Ballet Studio
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  • Please fill out this form to attend a placement class.

    Please fill out one form per dancer.

  • Dancer's Age Group*
  • Dancer Info

  • Date of Birth*
     / /
  • Placement Class

    Please select which class dancer would like to attend to be evaluated.
  • Ballet I Ages 6-7 (no experience required)
  • Ballet II Ages 8-10 (at least 1 year of Ballet experience recommended)
  • Lois Ellyn Ballet Studio Policies

  • Today's Date
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    2 digit month, 2 digit day, 4 digit year
  • Lois Ellyn Ballet Studio / Nouveau Chamber Ballet
    Liability, Personal Release & Studio Policies Agreement

    WARNING: As with any physical fitness program, dancing and dance exercises may result in injury. All students are urged to consult with their doctors regarding the advisability of participating in dance lessons and physical activity.

    Lois Ellyn Ballet Studio / Nouveau Chamber Ballet and its staff members assume no liability resulting from the student's/dancer's participation in our programs and/or use of the studio premises, including, but not limited to, physical injury, illness, or other personal injury.

    The student/dancer and/or their parent or legal guardian assume all risks associated with participation in dance classes, rehearsals, performances, and other studio activities, as well as while on the premises or traveling to or from the premises. This includes, but is not limited to, physical injury or illness.

    Dance Instruction and Physical Corrections
    Dance instruction may include respectful physical cueing or physical corrections when appropriate for instruction, alignment, placement, technique, or safety.

    If you or your dancer prefer not to receive physical corrections or physical cueing, you must notify Lois Ellyn Ballet Studio in writing and remind the instructor at the beginning of each class.

    Dress Code and Studio Rules
    All students are required to follow the dress code and other requirements outlined in the Lois Ellyn Ballet Studio Handbook and Welcome Packet.

    By signing this agreement, I acknowledge that I am responsible for reading, understanding, and following all rules, policies, procedures, dress codes, and expectations contained in the studio's Handbook and Welcome Packet.

    Students are expected to arrive prepared and dressed appropriately for their class, rehearsal, or activity. Failure to follow the required dress code or studio policies may result in the student being asked to sit out or otherwise be addressed according to studio policy.

    Studio Cameras and Recording
    I understand that security and/or studio cameras are present on the Lois Ellyn Ballet Studio premises and may record areas of the studio and surrounding premises for security, safety, and/or studio-related purposes.

    By entering the premises, I acknowledge and accept the presence of cameras.

    I further acknowledge that if I bring another person onto the studio premises—including, but not limited to, a parent, guardian, family member, friend, or guest—I am responsible for ensuring that the individual is aware that cameras may be present and that they may be recorded while on the premises.

    Resident Cats
    Please note that the studio is home to three resident cats. I understand that the cats may roam freely throughout the studio and class spaces.

    I understand and accept the potential risks associated with the presence of the cats, including, but not limited to, scratches, bites, allergic reactions, or other injuries or health reactions resulting from interaction with or proximity to the cats.

    I also understand that the cats may cause distractions during classes, rehearsals, or other studio activities. I agree that I will not hold Lois Ellyn Ballet Studio / Nouveau Chamber Ballet or its staff members liable for injury, illness, distraction, or other consequences resulting from interacting with or being in the presence of the resident cats.

    Photo, Video, and Likeness Release
    I hereby give permission for my/my student's likeness to be photographed, videotaped, filmed, or otherwise recorded during studio classes, rehearsals, performances, events, or other studio activities.

    I authorize Lois Ellyn Ballet Studio / Nouveau Chamber Ballet and its staff members to use these photographs, videos, or recordings for promotional, educational, social media, website, advertising, archival, or artistic purposes without additional compensation.

    Personal Belongings
    Lois Ellyn Ballet Studio / Nouveau Chamber Ballet is not responsible for lost, stolen, damaged, or misplaced personal belongings.

    Students and families are strongly encouraged not to leave valuable items unattended on the studio premises and should keep personal belongings with them whenever possible.

    Acknowledgment and Agreement
    By signing below, I acknowledge that I have read and understand this Liability, Personal Release & Studio Policies Agreement.

    I understand and agree to:

    Follow all rules, regulations, policies, and procedures contained in the Lois Ellyn Ballet Studio Handbook and Welcome Packet.
    Follow the required dress code for my/my student's class.
    Understand that dance instruction may include respectful physical cueing and corrections.
    Notify Lois Ellyn Ballet Studio in writing if I/my student does not wish to receive physical corrections and remind the instructor at the beginning of each class.
    Acknowledge the presence of cameras on the studio premises.
    Ensure that any guests I bring onto the premises are aware that cameras may be present and that they may be recorded.
    Accept the risks associated with participating in dance and physical activity.
    Accept the risks associated with the resident cats on the premises.
    Understand that Lois Ellyn Ballet Studio / Nouveau Chamber Ballet is not responsible for personal belongings left unattended.
    Grant permission for photographs, video, film, and likeness to be used for promotional, educational, social media, website, advertising, archival, and/or artistic purposes.
    Comply with all studio policies and expectations.
    I understand that by signing this agreement, I am acknowledging and accepting the terms outlined above and agreeing to comply with the policies of Lois Ellyn Ballet Studio / Nouveau Chamber Ballet.

  • Lois Ellyn Studio
    Home of Nouveau Chamber Ballet

    1090 W. Valencia Dr, Fullerton, CA 92833

    Email: loisellynballetstudio@gmail.com 

    Phone: (714) 526-3862

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