LICSB Registration Form
Welcome to LICSB! We will confirm your registration by email.
Student Name *
Your answer
Date of Birth *
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Parents Name
Your answer
Home Phone *
Your answer
Cell Phone
Your answer
Zip Code *
Your answer
Email *
Your answer
Medical Alerts
Your answer
Class Schedule
Class Day
Your answer
Class Name
Your answer
Class Time
Your answer
PARTICIPATION CONSENT


I understand that participation at The Long Island City School of Ballet is voluntary and requires students to abide by applicable safety rules and standards of conduct.
I understand that there are inherent risks associated with participation in classes, rehearsals and performances, and I release The Long Island City School of Ballet and all its employees, volunteers, and related parties from any and all claims or liability arising directly or indirectly from this participation.
I agree to indemnify The Long Island City School of Ballet for any costs, expenses, or liability arising out of my child’s participation, including the cost of any medical care that may be given to my child or any expenses or fees incurred by LICSB, or liabilities arising from any lawsuit resulting from any damage or injuries caused by my child in the course of his or her participation in the activity.
In case of an emergency involving my child, I understand that every reasonable effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to The Long Island City School of Ballet staff to secure proper treatment, including hospitalization, for my child. Medical care providers are authorized to disclose to the adult in charge of the child all examination findings, test results, and treatments provided for purposes of the child’s medical evaluation, follow up, and communication with the child’s parents or guardian, and/or determination of the child’s ability to continue in the program activities.


Students can not participate until a consent form is on file.


ELECTRONIC SIGNATURE
I understand that participation at The Long Island City School of Ballet is voluntary and requires students to abide by applicable safety rules and standards of conduct.
I understand that there are inherent risks associated with participation in classes, rehearsals and performances, and I release The Long Island City School of Ballet and all its employees, volunteers, and related parties from any and all claims or liability arising directly or indirectly from this participation.
I agree to indemnify The Long Island City School of Ballet for any costs, expenses, or liability arising out of my child’s participation, including the cost of any medical care that may be given to my child or any expenses or fees incurred by LICSB, or liabilities arising from any lawsuit resulting from any damage or injuries caused by my child in the course of his or her participation in the activity.
In case of an emergency involving my child, I understand that every reasonable effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to The Long Island City School of Ballet staff to secure proper treatment, including hospitalization, for my child. Medical care providers are authorized to disclose to the adult in charge of the child all examination findings, test results, and treatments provided for purposes of the child’s medical evaluation, follow up, and communication with the child’s parents or guardian, and/or
determination of the child’s ability to continue in the program activities.


Students can not participate until a consent form is on file.

*
Required
Type your name below to complete consent form *
Parent or guardian name
Your answer
Date signed *
Participation consent given on this date for 2017 -2018 Fall and Spring semesters, Summer programs and all LICSB and partners rehearsals and performances.
MM
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YYYY
Photo Release *
Required
Payment method *
Tuition must be paid in full before the first class and is non-refundable. PayPal invoices will be sent to the email entered above
Discount Code
Your answer
How did you hear about us? *
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