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SPB / NJ Open House Ballet class for ages 6-7.
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Family Information
First Name:
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Last Name:
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Relation to Student
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Caregiver
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Students entered below will be added to your family's account
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Student's First Name:
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Student Gender:
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Birth Date:
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Student Email:
Academic School:
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Birth Date:
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Student Email:
Academic School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
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Birth Date:
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Student Email:
Academic School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
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Student's First Name:
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Last Name:
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Student Gender:
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Male
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Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Academic School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Injuries (Leave blank if NONE):
Illness (Leave blank if NONE):
Social Media Handles :
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Non-Binary
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Academic School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Injuries (Leave blank if NONE):
Illness (Leave blank if NONE):
Social Media Handles :
Additional Information:
Medical Consent and Liability Waiver
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I am aware that dance and the nature of the training and performing associated with the School of Philadelphia Ballet place unusual stress on the body and carry with them the risk of physical injury. I shall indemnify, hold harmless and defend Philadelphia Ballet, its officers, boards, agents and employees, against any and all claims, actions, or suits brought for damages or alleged damages, and from all liability, loss and expense, including reasonable legal expenses, resulting from any injury to person or property or from loss of life sustained by my child while a student at the School of Philadelphia Ballet or while he/she is fulfilling a role in any Philadelphia Ballet production or event in which he/she has been invited to participate on or about Philadelphia Ballet premises or other venue where such activity is taking place including remote learning/online platforms.
I've read the above and agree.
Photo Consent
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I hereby consent to and authorize the use and reproduction by Philadelphia Ballet and the School of Philadelphia Ballet of any and all photographs, recordings, videotapes and/or other reproductions of my child's likeness for any purpose, whatsoever, without compensation. All images shall constitute the property of Philadelphia Ballet and the School of Philadelphia Ballet, solely and completely. Further, I assign and release all rights to said images and authorize Philadelphia Ballet, or others authorized by them, to exhibit, broadcast, and/or distribute or otherwise further reproduce said images in whole or in part over or in any medium whatsoever, including newsletters, radio, newspapers, film, cable and television.
I've read the above and agree.
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