Carolina Ballet Database/Health Information Form 2023
Required for Company and Non-Company Members
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Email *
Please select one: *
How would you like to receive the Rehearsal Schedule? *
Please enter the email or text that you would like to receive the schedule. *
Dancers Name: *
Dancers Academic School & District: *
Dancers Grade: *
Dancers Studio:
Dancers Cell Number:
Dancers Email:
Parent/Guardian #1 Name: *
Parent/Guardian #1 Contact Number: *
Parent/Guardian #1 Email: *
Parent/Guardian #2 Name:
Parent/Guardian #2 Contact Number:
Parent/Guardian #2 Email:
Home Address: *
Parents'/Guardian Occupation/Employer: *
Insurance Company: *
Policy Number: *
Insurance Co. Phone #:
Name of Insured:
Dancers Doctors Name: *
Dancers Doctors Phone #: *
Emergency Contact Name/Phone Number/Relation: *
EMERGENCY MEDICAL CONSENT:                                                                                                         In the event of a medical emergency, I authorize Carolina Ballet to seek emergency medical treatment for my child. *
RESPONSIBILITY ACCEPTANCE:                                                                                                                           I have read and agree to abide by the RESPONSIBILITY SHEET FOR PARENTS AND DANCERS, including the DRESS CODE REQUIREMENTS. (Check below to agree) *
Required
PHOTOGRAPH AGREEMENT:                                                                                                                     Carolina Ballet is authorized to use photographs of dancers and performers in productions. Photographs taken for or by Carolina Ballet may only be used and reproduced with the authorization of Carolina Ballet. (Please type parent/guardian name Below to agree) *
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