Online Adult Registration Form Name * First Name Last Name Date of Birth * Street Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Cell Phone * (###) ### #### Work Phone (###) ### #### Emergency Contact Name * First Name Last Name Emergency Contact Relationship * Emergency Contact Cell Phone * (###) ### #### Pertinent Medical History/Allergies I agree to allow New Bedford Ballet to send me emails. * Yes No NBB has my permission to use my photo/video for Promotions/Social Media * * Yes No I am able to help New Bedford Ballet with: Performances Fundraisers Maintenance Sewing Grants IT/Computer Carpentry Music Photography/Video Drawing/Graphics Marketing Legal Lighting/Sound System Other Skills Waiver * - New Bedford Ballet reserves the right to cancel class and/or substitute teachers when it feels appropriate. - Missed classes due to inclement weather or student illness should be made up at the same level or below. - 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 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 Waiver and to New Bedford Ballet's School Policies. 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 your registration!
