2025 Summer Intensive Program Enrollment ApplicationJune 30 – July 25 • Ages 13-22JMBT • 400 Harvard Street, CambridgePlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Student Information – Step 1 of 4Student InformationStudent Name *FirstLastDate of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920GenderOptionalPronounsOptionalGrade (24/25 academic year)SchoolHome Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWas the student enrolled in the 24/25 Young Dancers Program at JMBT? *YesNoParent/Guardian I InformationParent/Guardian Name *FirstLastEmail *EmailConfirm EmailCell Phone *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWork PhoneEmployerWould you be interested in volunteering with José Mateo Ballet Theatre?YesNoParent/Guardian II InformationParent/Guardian NameFirstLastEmailEmailConfirm EmailCell PhoneAddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWork PhoneEmployerWould you be interested in volunteering with José Mateo Ballet Theatre?YesNoEmergency Contact InformationAll students must submit an Emergency Contact person who is NOT their direct parent/guardian.Emergency Contact Name *FirstLastRelationship *Cell Phone *Additional InformationIs 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):How did you hear about José Mateo Ballet Theatre? *PosterMailingWord of mouthEmailFacebookInstagramInternet searchFrom my/my child’s school/nursery/daycareDancewear storeOtherOther *Please specifyNextDemographic SurveyDiversity and inclusion are at the core of José Mateo Ballet Theatre’s mission and commitment to the community. Gathering the information listed below allows us to improve the customer service that we give to all families. In addition, this information will further our diversity and inclusion efforts.This information will be kept anonymous and only be used to meet the needs of the families we serve.My child is (select all that apply):WhiteBlackAsianHIspanicPacific IslanderNativeOtherPlease specifyMy household income is:Less than $30,000$30,000-$60,000$60,000-$90,000$90,000-$120,000$120,000-$150,000$150,000-$200,000$200,000-$250,000Greater than $250,000What obstacles exist that prevent you from attending a José Mateo Ballet Theatre performance?Ticket CostNot InterestedChild CareLocation of TheatreNot enough timeNone, I attend JMBT performancesYour neighborhood is:(i.e., Winter Hill, Inman Square, Beacon Hill, Hyde Square, etc.)PreviousNextEnrollment AgreementI hereby enrollStudent Namein José Mateo Ballet Theatre’s 2025 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 SignatureToday's Date *Attendance and Participation AgreementJosé 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 SignatureParent/Guardian SignatureToday's Date *PreviousNextPayment InformationAre you applying for financial aid? *YesNoFinancial Aid Application MaterialsPlease upload a digital copy (e.g., scan, image, pdf) of your most recent tax filing below. This must include the IRS Form 1040 showing the student listed as a dependent and showing your Adjusted Gross Income.If you do not file taxes, please contact us registration@ballettheatre.org to discuss alternative income documentation.Tax Files * Click or drag files to this area to upload.You can upload up to 10 files. Statement of financial need *Statement of your child's interest in the study of dance *Statement of the family's willingness to support this interest *Statement of commitment to full participation in the program and the eligibility requirements/stipulations outlined in the Financial Aid section of the Young Dancers Program page *PaymentPayment Options *Payment in fullInstallment planIf paying in installments, the remaining two installments (of three total) will automatically be charged on May 15 and June 15 to the card used to make the first installment payment.Do you have a tuition code to enter? *YesNoIf unsure, select “No”.Tuition Code *Full TuitionPrice: $2,680.00First Tuition InstallmentPrice: $893.00The remaining two installments (of three total) will automatically be charged on May 15 and June 15 to the card used to make the first installment payment.Registration FeePrice: $25.00Total$0.00Payment InformationName on Card *FirstLastCredit Card Information *Card NumberMM123456789101112Expiration/YY2526272829303132333435Security CodeBilling Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSubmit
