STUDENT REGISTRATION FORM
Welcome to Ballet Academy & Movement!
We have a 3-part registration process:
(1) Complete this form, required before participating in classes, workshops/intensives/master classes at Ballet Academy & Movement. If student is under the age of 18, parent or legal guardian must complete and sign.
(2) Register for classes at
. If you are registering for a master class, intensive, or camp, you will still need to complete this form, as well as the registration form for that event.
(3) Finally, we will call you to get your payment information, required before participating in any classes, intensives, workshops, or camps. New students will pay a $40 registration fee.
Thank you for being part of our family!
Sign in to Google
to save your progress.
Adult's first & last name
Please enter your full name. If you're registering yourself, please enter your name here and in the Student's name field below.
Cell phone number
Please enter a phone with text capability.
Full Street Address (Street, City, State, Zipcode)
Please enter your full street address with city, state, and zipcode.
Please complete each question, listing all students who will be attending.
Student's First and Last Name
Only for students under 18. If you're older than 18, enter "n'a".
Prefer not to say
Previous Dance Experience
(1) Please tell us about your dance background, if any: Years in dance, preferred style(s), previous/current schools or programs, summer programs, etc. (2) If none, enter "None." (3) If registering for Pilates, Gyrotonic®, Stretching, or Yoga, enter "Other."
Current or previous competitive/company experience
Please list any competitive team or dance company experience.
Please tell us your Instagram handle, if you have one.
If you are registering a child with an IG handle, please tell us that too.
Have you already spoken with Ms. Cobb?
How did you hear about us?
Magazine or newspaper article
Google or web search
Magazine or newspaper ad
Organized group class?
Are you coming as part of a group class organized by someone else? If so, please tell us their name, organization (if applicable) and class type/time.
INSTRUCTIONS: This section must be read, acknowledged, and signed by an adult. For students under 18, this will be a parent or legal guardian.
While participating in events held or sponsored by Ballet Academy & Movement ("BAM") “social distancing” must be practiced to reduce the risks of exposure to COVID-19. Because COVID-19 is extremely contagious and is spread mainly from person-to-person contact, BAM has put in place preventive measures to reduce the spread of COVID-19. However, BAM cannot guarantee that its participants, volunteers, partners, or others in attendance will not become infected with COVID-19.
In light of the ongoing spread of COVID-19, individuals who fall within any of the categories below should not engage in BAM classes or events and/or other face to face activities. By attending a BAM class or event, you certify that you do not fall into any of the following categories:
(1) Individuals who currently or within the past fourteen (14) days have experienced any symptoms associated with COVID-19, which include fever, cough, and shortness of breath among others;
(2) Individuals who have traveled at any point in the past fourteen (14) days, either internationally or to a community in the U.S., that has experienced or is experiencing sustained community spread of COVID-19; or
(3) Individuals who believe that they may have been exposed to a confirmed or suspected case of COVID-19 or have been diagnosed with COVID-19 and are not yet cleared as non-contagious by state or local public health authorities or the health care team responsible for their treatment.
I understand and agree that I must come to the studio dressed for class and may not use the studio dressing rooms at Ballet Academy & Movement, until further notice.
I understand that I must use hand sanitizer before entering the studio (we provide).
DUTY TO SELF-MONITOR:
Participants and volunteers agree to self-monitor for signs and symptoms of COVID-19 (symptoms typically include fever, cough, and shortness of breath), to email BAM at
immediately if he/she experiences symptoms of COVID-19 within 14 days after participating at or volunteering with BAM, and to not attend BAM classes or events for the full 14 days and exhibiting no further signs or symptoms of COVID-19.
RELEASE AND WAIVER:
I HEREBY RELEASE, WAIVE AND FOREVER DISCHARGE ANY AND ALL LIABILITY, CLAIMS, AND DEMANDS OF WHATEVER KIND OR NATURE AGAINST BALLET ACADEMY & MOVEMENT ("BAM") AND ITS AFFILIATED PARTNERS AND SPONSORS, INCLUDING IN EACH CASE, WITHOUT LIMITATION, THEIR DIRECTOR, EMPLOYEES, VOLUNTEERS, AND AGENTS (THE “RELEASED PARTIES”), EITHER IN LAW OR IN EQUITY, TO THE FULLEST EXTENT PERMISSIBLE BY LAW, INCLUDING BUT NOT LIMITED TO DAMAGES OR LOSSES CAUSED BY THE NEGLIGENCE, FAULT OR CONDUCT OF ANY KIND ON THE PART OF THE RELEASED PARTIES, INCLUDING BUT NOT LIMITED TO DEATH, BODILY INJURY, ILLNESS, ECONOMIC LOSS OR OUT OF POCKET EXPENSES, OR LOSS OR DAMAGE TO PROPERTY, WHICH I, MY HEIRS, ASSIGNEES, NEXT OF KIN AND/OR LEGALLY APPOINTED OR DESIGNATED REPRESENTATIVES, MAY HAVE OR WHICH MAY HEREINAFTER ACCRUE ON MY BEHALF, WHICH ARISE OR MAY HEREAFTER ARISE FROM MY PARTICIPATION WITH THE ACTIVITY.
ASSUMPTION OF THE RISK.
I acknowledge and understand the following:
1. Participation includes possible exposure to and illness from infectious diseases including but not limited to COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist;
2. I knowingly and freely assume all such risks related to illness and infectious diseases, such as COVID-19, even if arising from the negligence or fault of the Released Parties; and
3. I hereby knowingly assume the risk of injury, harm and loss associated with the Activity, including any injury, harm and loss caused by the negligence, fault or conduct of any kind on the part of the Released Parties.
MEDICAL ACKNOWLEDGMENT AND RELEASE. I acknowledge the health risks associated with the Activity, including but not limited to transient dizziness, lightheaded, fainting, nausea, muscle cramping, musculoskeletal injury, joint pains, sprains and strains, heart attack, stroke, or sudden death. I agree that if I experience any of these or any other symptoms during the Activity, I will discontinue my participation immediately and seek appropriate medical attention. I DO HEREBY RELEASE AND FOREVER DISCHARGE THE RELEASED PARTIES FROM ANY CLAIM WHATSOEVER WHICH ARISES OR MAY HEREAFTER ARISE ON ACCOUNT OF ANY FIRST AID, TREATMENT, OR SERVICE RENDERED IN CONNECTION WITH MY PARTICIPATION IN THE ACTIVITY.
As a participant, volunteer, or attendee, You recognize for you of your child(ren), that the participation of, involvement and/or attendance at any Ballet Academy & Movement ("BAM") event or activity (“Activity”) is voluntary and may result in personal injury (including death) and/or property damage. By attending, observing or participating in the Activity, You acknowledge and assume all risks and dangers associated with you or your child(ren)'s participation and/or attendance at the Activity, and You agree that: (a) Ballet Academy & Movement ("BAM"), (b) the property or site owner of the Activity, and (c) all past, present and future affiliates, successors, assigns, employees, volunteers, vendors, partners, directors, and officers, of such entities (subsections (a) through (c), collectively, the "Released Parties"), will not be responsible for any personal injury (including death), property damage, or other loss suffered as a result of your or your child(ren)'s participation in, attendance at, and/or observation of the Activity, regardless if any such injuries or losses are caused by the negligence of any of the Released Parties (collectively, the "Released Claims").
BY ATTENDING AND/OR PARTICIPATING IN THE ACTIVITY, YOU ARE DEEMED TO HAVE GIVEN A FULL RELEASE OF LIABILITY TO THE RELEASED PARTIES TO THE FULLEST EXTENT PERMITTED BY LAW.
I, as Self (if over legal age), or as the parent or legal guardian of the student(s) listed on this form, grant my permission to use the photographs or videotapes taken during Ballet Academy & Movement (hereinafter referred to as "BAM") classes and performances for any legal use, but not limited to: publicity, copyright purposes, illustration, advertising, social media, and web content. Furthermore, I understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
Payments are prepaid automatically on the first of each month, as set up when you register. We offer a 10% discount. Please contact us to inquire.
Cancellations for Privates or Semi-Privates
Cancellations for privates or semi-privates must be made no later than 24 hours prior to your private or semi-private. Failure to do so will result in a $50 fee per missed private or semi-private.
Makeups, Refunds, and Withdrawals
Makeups for missed classes and privates are solely at the discretion of the instructor and Ms. Cobb, and must be arranged in advance.
Class Drop or Studio Withdrawal Policy: In order to drop a class or withdraw completely from BAM enrollment, you must email us at least 30 days before the 1st of the next month.
Monthly billing will continue until BAM Ballet Academy & Movement receives written or emailed notice. No exceptions will be made to this policy.
Refunds: No refunds will be made once a student is registered for the program. No refunds will be made if a student is dismissed for unacceptable behavior. No refunds for performance or studio fees (including costume fees) will be issued.
Please enter your full name to indicate that you have read, acknowledge, and accept all sections on this form.
We are excited to have you join us! If you have not already done so, please complete the class registration form (
), or the registration form for the master class/intensive/workshop.
We will be in touch to get your payment information. Note that new students as of August 2021 pay a $40 new student registration fee.
You will receive an e-mail of this registration form for your records.
A copy of your responses will be emailed to the address you provided.
Page 1 of 1
Never submit passwords through Google Forms.
This form was created inside of Ballet Academy & Movement.