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Trial or Placement Class Application
New Ballet School
Audition Location *
Student Last Name *
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Student First Name *
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Gender *
Previous Dance Studio
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Date of Birth *
MM
/
DD
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YYYY
Period of Study
(Total years of training at all schools)
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Years en pointe (if applicable)
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Academic School
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Grade Level
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New Ballet School is proud to be recognized as a school of diversity. Please indicate ethnicity: *
Parent/Guardian Name *
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Relationship to student *
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Address *
(Street)
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City *
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State *
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Zipcode *
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Email *
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Phone *
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Type of Phone Number listed *
Contact in Case of Emergency *
List name and phone
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Medical History
List allergies, pre-existing conditions, medications being taken
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Agreement and Release *
As an adult student or a parent/guardian of a student, I understand that New Ballet School (NBS) cannot be responsible for any injuries or damage suffered by my child during his/her participation in the Program. With this knowledge, I consent to my child’s participation in the Program. I further consent to my child’s participation in field trips and any other activity in connection with this program. I agree that neither my child nor I, as a parent/guardian, will institute any legal action or assert any claim against NBS for any injury or damage experienced by the student. As a parent/guardian, I am in full understanding of, and will comply with, tuition payment/refund policies as set forth by NBS. All students of NBS are expected to conform to the School’s policies, and conduct themselves in a disciplined, responsible and courteous manner at all times. I understand that NBS reserves the right to suspend or dismiss any student whose attitude, attendance or conduct is found to be unsatisfactory. I consent to the reproduction and/or use of photographs, videotapes and film or audio recordings of myself or my child/charge for advertising or promotional purposes by NBS. In an emergency situation, if I cannot be reached, I also hereby grant permission for a staff member of NBS to seek professional emergency medical treatment for my child. If, in the judgment of a qualified medical doctor or other personnel of an emergency treatment facility, medical assistance or treatment is required, this will authorize such assistance or treatment.
How did you hear about us? *
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Audition Fee-$35
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