Ensemble Requirements: Senior Ensemble: 2 hrs/wk of Jazz/Contemporary with 1 class/wk of Ballet and 1 hr/wk Monday Ensemble rehearsal Junior Ensemble: 2 hrs/wk of Jazz/Contemporary with 1 class/wk of Ballet and 1 hr/wk Monday Ensemble rehearsal Tap Ensemble: 1 hr/wk of Tap with 1 hr/wk of Jazz/Contemporary/Ballet and 45 minutes/wk Wednesday Ensemble rehearsal
Start Date/Time: End Date/Time:
Fee per Student: Room:
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Family Information
First Name:* Last Name: *
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Emergency Contact Info
(Not Contact #1 or #2)*
Students entered below will be added to your family's account
Previous dance school?*
Years of training in Ballet?*
Years of training on pointe?*
Years of training in Jazz/Contemporary?*
Years of training in Modern?*
Years of training in Hip Hop?*
Years of training in Tap?*
Current class(es) and Level?*
Are you available for Choreography Workshops?*
Additional Information:
Release of Liability
As the enrolled participant and/or the parent/guardian of the participant, I agree and understand that dance/fitness/ training is a potentially hazardous activity. I recognize that there are risks inherent in dance training including but not limited to serious physical injury. The participant hereby agrees to participate in activities of the Campaneria Ballet School (CBS) and hereby agrees to indemnify and hold harmless CBS, its instructors, officers, directors, agents and employees against any liability resulting from any injury that may occur to the participant while participating in activities of the CBS. The participant also agrees to indemnify CBS for any damages incurred arising from any claims, demand, action or course of action by the participant. The participant authorizes any representative of CBS to have the participant treated in any medical emergency during their participation in activities of the CBS. Further, the participant and/or parent/guardian agree to pay all costs associated with medical care and transportation for the participant.
• Any medical/health problems, of which the staff must be aware, are disclosed in the Important Health Information section of the Registration Form.

I've read the above and agree.
Audition Attire
• Black leggings or tights, with a black leotard or form fitted tank top.
• No crop tops or booty shorts.
• Hair must be pulled back and off the face into a pony tail.

I've read the above and agree.
Enter your Full Name: *   
Other Questions/Comments:
Credit Card Verification:
Card Number: *  
Name as it appears on card: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*