Student Name
*
First Name
Last Name
Student Birthdate
*
MM
DD
YYYY
Program Enrolling In: Please check the appropriate program below based on your acceptance email.
C/D Level:
9:00- 4:30pm Monday-Friday
4 weeks, June 3rd- 28th, 2024
A/B Level:
9:00-3:30pm Monday-Friday
4 week option June 3rd- 28th, 2024
2 week option June 17th- 28th, 2024
All students will participate in an end of program showcase on Friday, June 28th, 2024.
Student Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Student T-Shirt Size
*
Is the student a current US citizen?
*
Are the student's parents divorced?
*
Student's Cell Phone Number (If applicable)
(###)
###
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How did you hear about our program?
Primary Contact Name
*
Primary Parent or Guardian for students under 18 years. Students 18 and over may provide your own information here and and emergency contact under the Secondary Contact
First Name
Last Name
Primary Contact Relationship to Student
*
Select one
Mother
Father
Grandparent
Caretaker (Babysitter/Nanny)
Self (students 18 and over)
Other
Primary Contact Phone
*
(###)
###
####
Primary Contact Email
*
Secondary Contact Name
*
Secondary Parent/ Guardian or emergency contact for students under 18. In an emergency, the secondary contact will be called if we cannot reach the primary contact.
First Name
Last Name
Secondary Contact Relationship to Student
*
Select one
Father
Mother
Grandparent
Caretaker (Babysitter/Nanny)
Other
Secondary Contact Phone
*
(###)
###
####
Secondary Contact Email
*
Name
First Name
Last Name
Phone
(###)
###
####
Agreement to read Summer Intensive forms (emailed and on website) and to follow policies outlined therein.
*
Students under 18: Student and Parent/Gaurdian must agree to policies.
Students 18 and over: Student must agree
I/we have read the policies of the New Orleans Ballet Theatre Summer Intensive.
I/we agree to adhere to them while enrolled for the 2024 Summer Session as a student. I/we understand that failure to adhere to these policies may result in dismissal from the NOBT Summer Intensive.
Physical Limitations
*
Students should be aware that professional training in dance is extremely rigorous and is particularly stressful to the muscular and skeletal structures of both the upper and lower body. In addition, there are special considerations and care to be taken with the bone structure and muscles of the head, neck, shoulders, back, feet, ankles, lower legs, knees, thighs, and hip joints. Because of the susceptibility of dancers for injury to these muscles and bone structures, particular attention will be given at the time of audition and in subsequent evaluations to the dancer’s fitness in these areas and to the effects of stress placed upon these structures by the rigors of the dancer’s regimen.
In order to insure a positive training program at NOBT Summer Intensive, we ask that you inform us of any physical limitations that could prevent you from actively participating and performing fully in the program. If there are no physical limitations, check the appropriate box. If there are any physical limitations, please submit the medical release form signed by the student's physician. If any physical limitations arise between the time this form is submitted and the start of the program, the attendee agrees to notify NOBT staff immediately, and will resubmit this form, if necessary, with doctor approval.
The medical release form (if needed) can be found on page 8 of the handbook.
Student's Medical Insurance Carrier
*
Student's Insurance Policy #
*
1.
*
I understand that dance is a physical art form and injury is inherent. Every effort has been made to keep the studio a safe and appropriate environment for learning and performing dance class. If an injury does occur, the student or student's parent/guardian is responsible for medical expenses incurred and will not hold New Orleans Ballet Theatre liable.
2.
*
The Directors and Faculty are qualified to teach students at the appropriate level, and I understand that every effort has been made to place students at the appropriate level for their abilities.
3.
*
I understand that the student may be touched appropriately by the teacher in order to achieve a certain position of the body as it pertains to the dance form.
Electronic Signature
*
I hereby declare all of the above to be true to my knowledge. I understand all of the policies above and sign my name below as the student (18 and older) or as a legal guardian of the student (under 18).
Date
*
MM
DD
YYYY
