Online Student Registration Form STUDENT INFORMATION Class * Discovery I (Thursday) Discovery I (Saturday) Discovery II (Thursday) Discovery II (Saturday) Pre-Ballet I (Wednesday) Pre-Ballet I (Thursday) Pre-Ballet I (Saturday) Pre-Ballet II (Wednesday) Pre-Ballet II (Thursday) Pre-Ballet II (Saturday) Pre-Ballet III (Wednesday) Pre-Ballet III (Saturday) Adaptive Ballet Foundation (Tuesday only) Foundation (Thursday only) Foundation (Tuesday and Thursday) Ballet A Ballet B Ballet C Ballet D1 Ballet D2 Ballet E Student Name * First Name Last Name Date of Birth * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Student Phone (optional) (###) ### #### Student Email (optional) Pertinent Medical History/Allergies The following two questions are optional and are requested primarily for grant purposes. Do you consider your student to be Hispanic/Latino? Yes No In addition, select one or more of the following to describe your student: White Asian Black/African American Native American/Alaska native Hispanic/Latino Native Hawaiian/Pacific Islander Bi-racial Multi-Race Non-Hispanic PARENT/GUARDIAN INFORMATION Mother/Guardian Name First Name Last Name Mother/Guardian Work Phone (###) ### #### Mother/Guardian Cell Phone (###) ### #### Father/Guardain Name First Name Last Name Father/Guardian Work Phone (###) ### #### Father/Guardian Cell Phone (###) ### #### Email address for correspondence I agree to allow New Bedford Ballet to send me emails. * Yes No Preferred written language 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 EMERGENCY CONTACT INFORMATION Emergency Contact Name (other than guardians) * First Name Last Name Emergency Contact Relationship * Emergency Contact Cell Phone * (###) ### #### PERMISSIONS AND POLICIES NBB has my permission to use my child's photo/video for Promotions/Social Media. * Yes No Withdrawal * If a student is withdrawing from classes, parents/guardians need to inform the office in writing. All outstanding balances must be paid. If the office is not informed of a student’s withdrawal, their account will continue to be charged until a written notice is received. I agree. 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 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 New Bedford Ballet’s Tuition Payments and Waiver. I agree. Policies * - Read New Bedford Ballet’s School Policies and Bullying Contract in English or in Spanish. - I understand that New Bedford Ballet reserves the right to change its policies at anytime at its sole discretion. I have read the policies and I agree to abide by them. PAYMENT AND SIGNATURE Payment * Tuition is calculated on a thirty-six week school year. For your convenience, payments are divided into nine payments. Tuition and performance fees are non-refundable. Please refer to the class schedule/calendar for due dates of tuition and performance fee. Tuition can be paid with credit cards, cash or check. Any bank charges due to returned checks will be charged to the customer’s account. A credit card MUST be kept on file with New Bedford Ballet. In the event tuition or performance fee is not paid by the payment due date, your credit card will be charged for that payment. There will be a $10 late fee for tuition not paid by the due date. I would like to automatically have the tuition and the performance fee, if applicable, 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. Signature * By typing your name, you agree to the terms of this form. First Name Last Name Date * MM DD YYYY How did you hear about New Bedford Ballet? I am a current student. A family member or friend referred me. I came to one of New Bedford Ballet's performances. I saw on social media. I found through an internet search. I saw in a print advertisement. Other. Thank you for your registration.
