Spring Ballet Boot Camp Registration

Name*
First Last
Home Address*
Street Address Address Line 2 City State ZIP Code
Email*
Home Phone*
Cell Phone*
Emergency Contact*
Emergency Contact Phone Number*
How did you hear about us?*
Select Option(s)*
- Three Day Package ($130)
- One Day Package - Friday ($45)
- One Day Package - Saturday ($45)
- One Day Package - Sunday ($45)
- Per Class - Friday Ballet 3:30-5:00 ($20)
- Per Class - Friday Contemporary 5:15-6:15 ($15)
- Per Class - Friday Stretch and Strength 6:30-7:30 ($15)
- Per Class – Saturday Ballet 12:30-2:00 ($20)
- Per Class – Saturday Contemporary 2:15-3:15 ($15)
- Per Class – Saturday Stretch and Strength 3:30-4:30 ($15)
- Per Class – Sunday Ballet 12:30-2:00 ($20)
- Per Class – Sunday Contemporary 2:15-3:15 ($15)
- Per Class – Sunday Stretch and Strength 3:30-4:30 ($15)
Releases and Authorizations
Please review the following releases and authorizations then indicate your agreement below.
Tuition*
- I understand that I am responsible for the entire tuition for classes for which I have registered for. Tuition is non-refundable/non-transferable.
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 faculty member at the start of class.
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 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 for approval, and that Pennsylvania Ballet has the right to edit, abridge, excerpt, or delete any and all of my 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 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 am aware that dance and the nature of the training and performing associated with The School of Pennsylvania Ballet places unusual stress on the body and carries the risk of physical injury. I waive all rights and release Pennsylvania Ballet, its officers, boards, agents and employees, and shall indemnify, hold harmless and defend any such parties, except in cases of willful misconduct and gross negligence on their part, against any and all claims, actions, or suits brought for damages or alleged damages, and from all liability, loss and expense, including reasonable legal expenses, resulting from any injury to person or property or from loss of life sustained by myself or my child while a student at The School of Pennsylvania Ballet. If student is under the age of 18: I understand that as a parent/guardian I will be contacted if medical attention is required during class time. If I cannot be reached, I hereby authorize The School of Pennsylvania Ballet to arrange for treatment as necessary. I warrant that I am at least eighteen (18) years of age and that I have every right to contract for myself or my minor child in the above regard. My releases and authorizations shall be binding upon me, my minor child, and my heirs, representatives, and assigns.
Agreement*
- I agree to the above terms and conditions.

Spring Ballet Boot Camp Registration

April 3, 4 & 5, 2020

Releases and Authorizations

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