Summer Ballet Student Registration Form 2024 Student Name * First Name Last Name Date of Birth * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Class * Discovery I Discovery II Pre-Ballet I Pre-Ballet II Pre-Ballet III Foundation Ballet A Ballet B Ballet C Ballet D1 Ballet D2 Ballet E Pertinent Medical History/Allergies Student Email (optional) Parent/Guardian Email * I agree to allow New Bedford Ballet to send me emails. * Yes No Mother/Guardian Name First Name Last Name Mother/Guardian Work Phone (###) ### #### Mother/Guardian Cell Phone (###) ### #### Father/Guardian Name First Name Last Name Father/Guardian Work Phone (###) ### #### Father/Guardian Cell Phone (###) ### #### Emergency Contact Name (Other than guardians) * First Name Last Name Emergency Contact Relationship * Emergency Contact Cell Phone * (###) ### #### NBB has my permission to use my child's photo/video for Promotions/Social Media * * Yes No I am able to help New Bedford Ballet with: Performances Fundraisers Maintenance Sewing Photography/Video IT/Computer Carpentry Music Grants Drawing/Graphics Attendance * I WILL be attending all 6 weeks of New Bedford Ballet's Summer Program I WILL be participating in the Performance Workshop ($50 Foundation - Level D1; $225 Levels D2-E including Choreography Workshop and Dance Extension) I WILL NOT be attending all 6 weeks of New Bedford Ballet’s Summer Program Absence Dates If you WILL NOT be attending all 6 weeks of the Summer Program, or if you will be in class only part of a week, please enter the week(s)/day(s) you will not be in attendance. Payment * Tuition is for the 6-week program. Tuition will not be pro-rated for students who only attend part of the program. One half of the tuition is due by May 20, 2024, with the balance being due on or before the first day of class. Current New Bedford Ballet students that sign up after the May 20th deadline will be subject to a $25 late fee. Tuition is non-refundable after May 20, 2024. Tuition can be paid with a credit card, cash or check. A credit card MUST be kept on file with New Bedford Ballet. In the event tuition is not paid by the first day of class, your credit card will be charged for that payment. This also includes the performance workshop. Any bank charges due to returned checks will be charged to the customer’s account. Yes, I would like to automatically have the tuition charged to my credit card. I would like to pay by check, cash or credit card, but understand that if I do not make the payment by the agreed upon due date, my credit card will be charged. Withdrawal * If a student is withdrawing from classes, parents/guardians need to inform the office in writing. All outstanding balances must be paid. I agree. Waiver * New Bedford Ballet reserves the right to cancel class and/or substitute teachers when it feels appropriate. New Bedford Ballet reserves the right to dismiss a student from the school. I understand that I will be held fully responsible for accident insurance for my child and/or myself and will not hold New Bedford Ballet or any of its faculty and staff responsible for injury sustained during or as the result of classes or performances. I have read, understand and agree to the above New Bedford Ballet payments, policies and waiver. New Bedford Ballet reserves the right to change its policies at anytime at its sole discretion. I agree. Signature * By typing your name, you agree to the terms of this form. First Name Last Name Date * MM DD YYYY Thank you for registering for New Bedford Ballet’s Summer Program.
