Year Round After School Program Enrollment Contract
Please complete this form to register for Kirov Academy of Ballet's After School Program for the 2018-2019 school year.

IMPORTANT: This is a quick three-step process after filling out the form; the first step is the payment, the second step is retrieving and then entering the BluePay Transaction ID number into the end of this form, the third step is submitting this form.

1) After you sign and date this form, there is a BluePay link you need to follow to pay the Non-refundable Registration Fee and another to pay the tuition if you choose.

2) After completing the payment, check your email to retrieve the Transaction ID number. Please then return to this contract page and enter the Transaction ID number into the last space in this form.

3) Click the SUBMIT button to complete your enrollment.


Your enrollment is complete and your spot is secured ONLY after you have completed the Registration Fee and minimum payment of $55 and we have received a fully completed form.

After payment is complete, you will receive a statement from the Finance Department (final tuition amount depending on the program). After this enrollment contract form is submitted, you will receive a copy of the Information Sheet from Kirov Academy staff.

Intro
Please select the class you would like to enroll your child in.
Please Choose an After School Program *
After School Program Children's Division Schedule
After School Program Pre-Academy Schedule
After School Program Fees
Applicant Information
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Age *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Gender *
Academic Grade Level for 2018-2019 (type N/A if not applicable) *
Your answer
Primary Phone *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
ZIP *
Your answer
Parent/Guardian 1 Information (type N/A if not applicable)
1 First Name *
Your answer
1 Last Name *
Your answer
1 Relation to Dancer *
1 Gender *
1 Lives with Dancer *
1 Is Emergency contact? *
1 Email *
Your answer
1 Cell Phone *
Your answer
1 Home Phone *
Your answer
Parent/Guardian 2 Information (only if applicable)
2 First Name
Your answer
2 Last Name
Your answer
2 Relation to Dancer
2 Gender
2 Lives with Dancer
2 Is Emergency Contact?
2 Email
Your answer
2 Cell Phone
Your answer
2 Home Phone
Your answer
Medical Insurance Information
Primary Insurance Provider *
Your answer
Phone # *
Your answer
Policy # *
Your answer
Group # *
Your answer
Subscriber Full Name *
Your answer
Relationship to Applicant *
Your answer
Subscriber Birthdate *
MM
/
DD
/
YYYY
Allergies (if applicable)
Please list below any allergies or health conditions that could affect the participant's class participation:
Your answer
Entry/Exit Permissions
Sign In/Out Procedures:

Adults will sign in/out at the front desk; children must be signed in/out by an adult whose name must be on our list of parents/adults allowed to pick them up/drop them off.

Adult visitors will be given a badge to wear while in the building that must be returned upon signing out.

Please list the names of any adults, other than parents or guardians, who will be coming with or picking up the applicant. Only those listed will be allowed to enter the building and/or pick up the applicant. *
If you do not wish to add anyone or if this is not applicable, type N/A.
Your answer
Uniform Orders
Applicable to ballet classes ONLY.

Each class has a color-coded leotard with our swan logo (except Children's Division and Prep-Ballet).

Class attire & uniforms will be available online through our partnership with Footlights Theater & Dance Boutique. Go to http://dancefootlights.com/products/yourstudio-kirov to purchase your uniform.

After School Program and Adult Ballet students from all levels must purchase at least one KAB uniform from Footlights WITHIN THE FIRST WEEK OF CLASSES.

PRICE:

The leotards from Footlights range from $28.00 - $38.00.

OTHER ATTIRE/DRESS CODE:

All other dance attire (including Boys' attire) is listed on the Information Sheet (available on website, this form, and will be emailed to you as a link) and can be purchased at both Footlights and the Kirov Boutique.

PURCHASE:

Please purchase leotards through ONE of the two ways listed below:

1.. Go to www.dancefootlights.com → click on schools, click on ‘Kirov Academy' or click on http://dancefootlights.com/products/yourstudio-kirov
2. Go to any Footlights shop in the Maryland or Virginia area

*You receive a 10% discount when purchasing through the Kirov website.


Orders made through Footlights can be shipped directly to and picked up from Kirov Academy.

If you have any questions about the uniform, Footlights or the Kirov Boutique, please contact the Boutique Manager, Karen Cerkez, at cerkez@kabdc.org.

Non-Refundable Registration Fee
$55.00
ENROLLMENT CONTRACT
By signing this Enrollment Contract, the Parent/Legal Guardian acknowledges the following provisions:

1. I acknowledge that Kirov Academy of Ballet (KAB) will issue 50% refunds for withdrawal up to 30 days in advance of the first day of class. NO REFUNDS WILL BE ISSUED ONCE CLASSES HAVE STARTED. Participation is suspended until minimum payment is received. All withdrawal requests must be made in writing to the Artistic Director.

2. I understand this is an enrollment and tuition commitment for the FULL 2018-2019 school year (or full semester) regardless of early withdrawal or missed classes.

3. I acknowledge that KAB reserves the right to retract enrollment at any time, for any reason, such as: behavior, attendance, or late payments.

4. I agree that the Academy is not liable and is held harmless from any losses, injuries, damages or expenses related to the above-named applicants' participation as well as visitors in association with the above-named applicant. Any and all claims against the Academy are waived. In turn, any damage and/or harm caused by the applicant and/or visitors will be the responsibility of him or herself, or the parent/legal guardian.

5. I acknowledge that the above-named applicant will be physically touched from time to time during his/her dance training and will not hold the Academy liable for such touching.

6. I give permission to the Academy to photograph and/or videotape the applicant, during the time he/she is enrolled, for publicity, press, and/or in-house purposes.

7. Kirov Academy of Ballet (After School Program) reserves the right to make any changes as needed, with or without notice.

8. I understand that KAB is not responsible for re-scheduling classes cancelled due to inclement weather or other "city-wide emergencies." Make up classes are determined by KAB on a case-by-case basis and are not guaranteed.

Applicant or Parent/Legal Guardian Electronic Signature
I have read and agree to all provisions of this Contract. All electronic signatures on this form and their related fields are treated by Kirov Academy of Ballet as a wet signature (a physical, handwritten signature on a paper form). I agree to enter into this Contract by electronic means.
Check the box: *
* I (We) have read and agree to all provisions of this Enrollment Contract. The electronic signature below and its related fields are treated by Kirov Academy of Ballet as a wet signature (a physical, handwritten signature on a paper form). I (We) agree to enter into this Contract by electronic means. I (We) have been provided with the amounts that I (we) must pay according to the 2018-2019 Classes and Schedule and I (we) agree to pay this amount.
Required
Please type your first and last names: *
Your answer
Date of Signature *
MM
/
DD
/
YYYY
Payment
Please click the link(s) below to pay the enrollment fee & tuition. After completing the payment, check your email to retrieve the BluePay Transaction ID number. Please then return to this contract page and enter the Transaction ID number into the space below.


Non-Refundable Registration Fee:
https://pay.kirovacademydc.org/bankwire

Tuition Fee - if you want to pay now (for specific amounts, please see fees and Info Sheet below):
https://pay.kirovacademydc.org/bankwire


TUITION MUST BE PAID BEFORE STARTING CLASS. THE STUDENT WILL NOT BE ALLOWED TO PARTICIPATE UNTIL TUITION IS PAID.

(The schedule and fees are shown again below for your reference.)

Info sheet:
https://gallery.mailchimp.com/ff1474961137e7965d58db3b1/files/c166f304-6593-4aba-94a3-82a54e4df50c/ASP_2018_19_Info_Sheet.01.pdf

After School Program Children's Division Schedule
After School Program Pre-Academy Schedule
After School Program Fees
ENTER your BluePay Transaction ID Here *
Your enrollment is complete and your spot is secured ONLY after you have completed the minimum payment of $55.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Kirov Academy of Ballet. Report Abuse - Terms of Service - Additional Terms