2024 Summer Intensive Program Enrollment Application

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Student Information – Step 1 of 4

Student Information

Student Name

First

Last

Select One:

New student
Returning student

Date of Birth

Gender

Optional

Grade

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

School

Dance School

Parent/Guardian I Information

Parent/Guardian Name

First

Last

Confirm Email

Cell Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Work Phone

Employer

Would you be interested in volunteering with José Mateo Ballet Theatre?

Parent/Guardian II Information

Parent/Guardian Name

First

Last

Confirm Email

Cell Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Work Phone

Employer

Would you be interested in volunteering with José Mateo Ballet Theatre?

Emergency Contact Information

(other than Parent/Guardian)

Emergency Contact Name

First

Last

Relationship

Cell Phone

Additional Information

Is there any medical information about your child that we should be aware of or that would be useful to your child's teachers?

Please include here any additional members of the family or household (e.g., siblings and their ages) that may be helpful to the teacher’s understanding of the student’s family or social context:

Please list any activities, hobbies or other strong interests, aside from dance, that are a regular part of the student’s extra-curricular experience:

Language(s) spoken at home (other than English):

Enrollment Agreement

I hereby enroll

Student Name

in José Mateo Ballet Theatre’s 2024 Summer Intensive Program.

I understand that payment is due in full at the time of enrollment or in three installments (the first due at the time of enrollment, the second due May 15, and the third due June 15).

I understand that, should the student, for whatever reason, be unable to participate, withdraw from the program, be dismissed with cause, or be absent from the program, payments will not be refunded. For students paying in installments, any remaining installments will still be due.

I am aware that ballet training and the exercises associated with it can place stresses on the body and can risk physical injury. On behalf of the above named student and myself, I assume this risk and agree that José Mateo Ballet Theatre will not be liable in any way for injuries sustained during participation in the program or related activities.

I grant José Mateo Ballet Theatre the right to make and use photographic and audiovisual documentation of my child to be used for philanthropic, promotional, and other mission related purposes. In no case will the child’s identity be disclosed without written parental consent.

I understand that the primary method of communication from José Mateo Ballet Theatre is email through Constant Contact or Gmail in order to send announcements and other pertinent studio information.

Parent/Guardian Signature

Today's Date

Attendance and Participation Agreement

José Mateo Ballet Theatre Summer Intensive Program students must:

• Remain committed to attending the full program or the portion of the program for which they have enrolled.

• Comply with all rules and regulations of José Mateo Ballet Theatre including, but not limited to, dress code, punctuality, and class etiquette.

• Attend and be on time to all scheduled classes. Students may not be late to class more than three times or have more than two absences during the course of the program.

• Participate in all scheduled classes, activities, and other organizational programs.

• Seek and receive permission from artistic staff before enrolling in additional dance classes or accepting a performance engagement.

Failure to comply with these policies may affect a student’s eligibility for performance opportunities and financial aid. We understand that some circumstances may make these policies difficult. We ask that you communicate honestly with us about any challenges that may prevent your child from participating fully in the program. We will do our very best to work with you to help your child to get the most out of the program, and we are thrilled to have them dance with us.

If there are any conditions that will prevent your child’s full participation in the program, please describe them here:

If there are any dates your child will be absent or late, please list them here along with the reason for the absence/lateness, please list them here:

Student Signature

Parent/Guardian Signature

Today's Date