LICSB Registration Form

Welcome to LICSB! We will confirm your registration by email.

USE THIS FORM FOR SPRING AND FALL REGISTRATIONS ONLY

For summer programs, please return to website homepage and follow the link for SUMMER BALLET
Thank you!

Student Name *

Your answer

Date of Birth *

YYYY

Parents Name *

Your answer

Home Phone *

Your answer

Cell Phone

Your answer

Email *

Your answer

Zip Code *

Your answer

What academic school is your child currently attending? *

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.

I hereby give my permission for my child to participate at the Long Island City School of Ballet.

Required

Type your name below to complete consent form *

Parent or guardian name

Your answer

Date signed *

Participation consent given on this date for Fall and Spring semesters, Summer programs and all LICSB and partners rehearsals and performances.

YYYY

Photo Release *

I hereby give permission for LICSB to use photographs and other digital media forms of my child in its publications and advertising materials and on its Web site (www.licsb.com).

I DO NOT give permission for LICSB to use photographs and other digital media forms of my child

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

Check - no extra fees

Paypal invoice - incurs 2.9% transaction fee

Discount Code

Your answer

How did you hear about us? *

Internet search

Social Media

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Walked by/ Was in Building

Other:

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