Registration 2022-2023

DP STUDIO OF CLASSICAL BALLET
2022-2023 Registration Form & Waivers
Classes begin August 8th, 2022
Registration fee: $50 (can be paid via Venmo @dpclassicalballet or by check to DP Studio)
Spring Recital fee - performance May 20, 2023: $50 (can be paid via Venmo @dpclassicalballet or by check to DP Studio)

* Indicates required field

Name (Student) *

First

Last

Date of Birth *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Name (Mother) *

First

Last

Cell Phone *

Name (Father) *

First

Last

Cell Phone *

Home Phone *

Parent's Email *

Home Phone *

Student's Email (Optional) *

Please list the day(s) and time(s) of classes you are signing your child up for: *

Tuition Payment Agreement Form 2022-2023

I/We agree to pay The Diane Partington Studio of Classical Ballet the tuition and all fees for the attendance of my/our child(ren) as established by the school for the 2022-23 school year. I understand that if my monthly tuition is paid after the 10th of each month, I will be charged a $15 late fee.
A $50 non-refundable registration fee is required at the time of registration, along with a $50 recital fee for participation in the Spring performance taking place on May 20, 2023.

Person Responsible for Account *

Address (If different from above) *

Line 1

Line 2

City

State

Zip Code

Country

Electronic Signature of Parent/Legal Guardian *

PARTICIPATION/MEDICAL AGREEMENT RELEASE FORM
(TO BE SIGNED BY PARENT OR LEGAL GUARDIAN)
I, the undersigned, understand and agree that dance and participation with the DP Studio of Classical Ballet is a strenuous, physically demanding activity which could but not likely to result in injury. I certify to the DP Studio of Classical Ballet, it’s agents, servants, employees, organizers, volunteers, faculty and staff that I/my child am/is physically capable of participating in all activities, programs, classes, performances and that I/my child expressly assumes the risk of personal injury arising from my/my child’s participation in all activities, programs, classes and performances of the DP Studio of Classical Ballet. I hereby release, remise, acquit and otherwise hold harmless the DP Studio of Classical Ballet it’s agents, servants, employees, organizers, volunteers, faculty and staff from and against any claims, suits and causes action for any injury, illness, property damage or loss incurred or sustained during my/my child’s participation with the DP Studio of Classical Ballet and arising in whole or in part from negligence or other misconduct of any individual or entity, including by not limited to the DP Studio of Classical Ballet it’s agents, servants, employees, organizers, volunteers, faculty and staff. I hereby grant permission to transport myself/my child to a medical doctor or hospital in case of illness or injury, and I/my child may receive treatment, as deemed medically necessary, by a licensed physician in the event of an injury.
(Required in case of Medical Emergency)

Participant's/Parent's Medical Insurance Company *

Student's Full Name *

First

Last

Policy Number *

E-Signature of Parent or Legal Guardian *

Please list any medical conditions your child has or has had in the past: (If none - please enter "N/A") *

Please list any medications your child takes: (If none - please enter "N/A") *

Please list any previous injuries your child has had: (If none - please enter "N/A") *

COVID-19 Liability Release Waiver

Classes will be drop off/pick up only - the lobby will be closed to all parents and siblings until further notice.
In consideration of my/my child's participation at the Studio of Classical Ballet , the undersigned acknowledges and agrees to the following:

Common COVID 19 Symptoms:
- Fever or chills
- Muscle or body aches
- Shortness of Breath
- Dry cough
- Fatigue
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting

I understand the above symptoms and acknowledge that upon returning to the studio I am responsible for informing the Studio of Classical Ballet if any household members have experienced the symptoms listed above or have tested positive for COVID 19.
I understand that The Studio of Classical Ballet cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each student.
I understand that I am responsible for informing The Studio of Classical Ballet immediately if my child or any household members test positive for COVID 19 - and understand that my child will need to stay home from ballet for at least 5 days or until a Negative test is acquired.

If you, or any household members have tested positive for COVID 19 please list who, when, and if said person has since tested negative (Please enter "N/A" if no one has been sick): *

*** By signing below I acknowledge that I have read and agree to each above statement and release The Diane Partington Studio of Classical Ballet Inc. from any and all liability for the unintentional exposure or harm due to COVID-19. The Diane Partington Studio of Classical Ballet Inc. and all employees of this facility agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions.

Electronic Signature of Parent or Legal Guardian *

Media Release Form
I grant to The Studio of Classical Ballet, it's representative and employees the right to use my child's/children's ballet photograph and/or ballet video in connection with the above-identified subject. I authorize the Studio of Classical Ballet, it's assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that The Studio of Classical Ballet may use such ballet photographs and/or ballet video of my child/children with or without his/her/their names for any lawful purpose, including for example such purposes as, publicity, illustration, advertising and web content.

Electronic Signature of Parent or Legal Guardian: *

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