Northwest Arkansas Conservatory of Classical Ballet Private Lesson Consent Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Northwest Arkansas Conservatory of Classical Ballet Private Lesson Consent Form

This form must be completed and signed by a parent or legal guardian prior to a student beginning private lessons with a faculty member.

Student Information

Student Name: *

Student Date of Birth *

YYYY

Current Class Level: *

Parent/Guardian Information

Parent/Guardian Name: *

Parent/Guardian Phone Number: *

Parent/Guardian Email: *

I consent to a faculty member communicating with my child directly regarding private lessons at the phone number and/or email provided below. *

Yes

Required

(If checked YES above, please provide contact information below)

Student Phone Number:

Student Email:

Teacher Selection

Please provide the name of your chosen instructor for private lessons:

Instructor Name: *

Lesson Agreement

Private lessons are scheduled directly between the teacher and the parent. Lesson times are subject to availability and studio scheduling.

Private lessons are a supplement to regular class attendance and not a replacement.
Students must arrive warmed up and ready to dance.
Payment policies, cancellation policies, and make-up procedures will be communicated by the teacher.
Lesson fees are paid directly to the instructor unless otherwise arranged.
A parent/legal guardian is always welcome to observe the session.

Supervision and Building Use

I understand that due to the nature of private lessons, there may be times when the student and teacher are the only individuals in the building during the lesson. I acknowledge and consent to this arrangement, and understand that the Northwest Arkansas Conservatory of Classical Ballet faculty will instruct using professional standards at all times. *

I understand and consent to private lessons potentially occurring when the teacher and student are the only individuals in the building.

I do not consent to lessons occurring unless another staff member, parent, or student is present in the building.

Required

Studio Use Acknowledgment

Due to scheduling and space limitations, some private lessons may be held in Studio C. Studio C is a smaller space and may require the doors to remain closed for sound quality and focus.

Please indicate your preference below:

Yes, I consent to my child taking private lessons in Studio C with the doors closed when necessary.

No, I prefer my child not to take private lessons in Studio C with the doors closed.

Required

Waiver and Consent

I, the undersigned parent or legal guardian, understand and acknowledge the nature of physical activity involved in private dance instruction. I agree to release and hold harmless the Northwest Arkansas Conservatory of Classical Ballet, its faculty, and its staff from any and all claims of liability or damages arising out of my child’s participation in private lessons.

I grant permission for my child to receive private instruction with an assigned faculty member of the Conservatory. I understand all scheduling and payment arrangements are made directly with the instructor unless otherwise noted.

Please type your name below to sign:

Date: *

YYYY

FOR OFFICE USE ONLY:

Teacher Signature:

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms