Pre and Less Intensive Registration Form

Please select the level you are registering for: *

Student's Last Name: *

Student's First Name: *

Student's Middle Initial: *

Age as of June 1, 2013: *

Parents/Guardian Names: *

Student Cell Phone:

Mother Home Phone:

Father Home Phone:

Mother Work Phone:

Father Work Phone:

Mother Cell Phone:

Father Cell Phone:

Student Street Address: *

City: *

State: *

ZIP Code: *

Date of Birth: *

Academic School: *

Grade Level (Fall 2012): *

Current Dance School:

Student Email:

Parent/Guardian Primary Email: *

How did you hear of the summer program:

Guardian Home Phone:

Guardian Work Phone:

Guardian Cell Phone:

Please select all to indicate your agreement with the following statements: *

I hereby state that the student (name listed above) is in good health and physical condition and is capable of participation in this program. I understand that the Ballet West Academy has the right to deny admittance to any student not meeting the standards of the program as it sees fit. I understand that he/she will be dancing at an appropriate level with the following expectations of training time per day: Intermediate 1 – up to 6 hours per day, five days a week; Elementary 1 & 2 – up to 5 hours per day, five days a week; Foundations 2 –up to 1.5 hours per day, 3 days a week; Foundations 1 –up to 1.5 hours per day, 2 days a week; Preparatory 1 or 2, or Ballet Basics –up to 1 hour a day, once a week

I attest that he/she is prompt, dependable, attentive and cooperative.

I also agree that I will not hold the Ballet West Academy, Ballet West, or any faculty member of employee liable for injuries sustained or illnesses contracted while he/she is a student at the Ballet West Academy Summer Pre- or Less-Intensive Program. I also agree not to hold these parties responsible in the event that my son/daughter engages in inappropriate conduct or becomes involved in any activity or with any persons not associated with the Ballet West Academy or its scheduled program and that Ballet West Academy has the right to send him/her home for inappropriate conduct. I further attest that the information contained in this application is correct to the best of knowledge. In addition, I have read the policy and fee statement and agree to comply.

May we include your contact information in the student directory: *