Adult Registration

Student Information

Student Name*

First Last

Home Address*

Street Address Address Line 2 City State Zipcode Country

Email Address*

Phone Number*

Gender

Male
Female

Employer

Please choose one:*

Student with valid ID
Equity card holder
SAG-AFTRA card holder
None of the above

Releases and Authorizations

Please review the the following releases and authorizations then indicate your agreement below.

Instructional Understanding*

It is understood that the nature of dance instruction involves kinetic corrections that may include physically touching a student as part of regular class work and rehearsals. Students with any concerns in this area should speak with the School Director.

Photo Consent*

I hereby consent to and authorize the use and reproduction by Pennsylvania Ballet of any and all photographs, recordings, videotapes and/or other reproductions of my child's likeness for any purpose, whatsoever, without compensation. All images shall constitute the property Of Pennsylvania Ballet, solely and completely. Further, I assign and release all rights to said images and authorize Pennsylvania Ballet, or others authorized by them, to exhibit, broadcast, and/or distribute or otherwise further reproduce said images in whole or in part over or in any medium whatsoever, including newsletters, radio, newspapers, film, cable and television. I agree that no material need be submitted to me or my child for approval, and that Pennsylvania Ballet has the right to edit, abridge, excerpt, or delete any and all of my child's likeness. I waive all rights and release Pennsylvania Ballet, its officers, boards, agents and employees, from any claim or cause of action, whether now known or unknown, for defamation, intentional or negligent infliction of emotional distress, invasion of right to privacy, publicity, personality, violation of any other property or moral rights, or any similar matter, based upon or relating to the use and exploitation of my child's likeness. I further waive and release any claim or cause of action related to any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur in capturing the likeness or in any subsequent processing or production.

Medical Consent and Liability Waiver*

I understand that in submitting this Registration Form (electronically), I am agreeing to accept the guidelines of The School of Pennsylvania Ballet as set forth above. SPB reserves the right to terminate a student's enrollment if they are unable to participate in accord with the school expectations of attendance or conduct. I understand that violation of any rule maybe grounds for instant dismissal from the school. I understand that should my actions warrant, I may be asked to leave The School. In such situation I understand no refund of tuition or fees will be forthcoming.

Agreement*

I agree to the above terms and conditions.

School Registration Form - Adult (5-Class Card)

Student Information

Releases and Authorizations

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