ADULT INTRODUCTION TO BALLETENROLLMENT APPLICATIONPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.1Student Information2Demographic Survey3Enrollment Agreement4Class Selection and TuitionSTUDENT INFORMATIONNAME *FirstLastLayoutDATE OF BIRTH *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Select one: *New studentReturning studentADDRESS *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLayoutEMAIL *EmailConfirm EmailPHONE *ADDITIONAL INFORMATIONIs there any medical information about you that we should be aware of or that would be useful to your teachers? *If there are any conditions that will prevent your full participation in the program, please describe them here. *If there are any dates you will be absent or late, please list them here. *Would you be interested in volunteering with José Mateo Ballet Theatre? *YesNoEMERGENCY CONTACTNAME *FirstLastRELATIONSHIP *PHONE *NextDEMOGRAPHIC 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 our students. 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 students we serve. I am (select all that apply):WhiteBlackAsianHispanicPacific IslanderNativeOtherPlease specifyThe primary language spoken in my home is:EnglishSpanishFrenchAmharic/EthiopianChinese/MandarinSwedishHebrewTurkishGermanItalianFarsiArabicJapanesePortugueseRomanianSlovakRussianPatoisCreoleOtherPlease specifyMy household income is:Less than $30,000$30,000-$60,000$60,000-$90,000$90,000-$120,000$120,000-$150,000More than $150,000What obstacles exist that prevent you from attending a José Mateo Ballet Theatre performance?Ticket CostNot InterestedChild CareLocation of TheatreNot enough timeNone, I attend JMBT performancesMy neighborhood (i.e., Winter Hill, Inman Square, Beacon Hill, Hyde Square, etc.) is:PreviousNextENROLLMENT AGREEMENTI,Student Name, hereby enroll in José Mateo Ballet Theatre’s Adult Dancers Program.I understand that payment is due in full at the time of enrollment.I understand that after an enrollment application has been received by José Mateo Ballet Theatre, should I, 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.I am aware that ballet training and the exercises associated with it can place stresses on the body and can risk physical injury. 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 me to be used for philanthropic, promotional, and other mission related purposes. (In no case will your identity be disclosed without written 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 information.LayoutSignatureDate: 09/22/2023PreviousNextCLASS SELECTIONLayoutIntro IIntroduction to Ballet Level IMonday and Wednesday 6:30-8:00pmIntro IIIntroduction to Ballet Level IITuesday and Thursday 6:30-8:00pmSESSION *Fall Session I | October 2, 2023 – November 1, 2023Fall Session II | November 6, 2023 – December 6, 2023Winter Session I | January 8, 2024 – February 7, 2024Winter Session II | February 12, 2024 – March 13, 2024Spring Session I | March 18, 2024 – April 17, 2024Spring Session II | April 22, 2024 – May 22, 2024Note: There will not be class onSESSION *Fall Session I | October 3, 2023 – November 2, 2023Fall Session II | November 7, 2023 – December 7, 2023Winter Session I | January 7, 2024 – February 8, 2023Winter Session II | February 13, 2024, – March 14, 2024Spring Session I | March 19, 2024 – April 18, 2024Spring Session II | April 23, 2024 – May 23, 2024TUITIONTuitionPrice: $ 175.00Tuition Price: $ 350.00Total$ 0.00PAYMENT INFORMATIONCREDIT CARD *Card NumberMM123456789101112Expiration/YY2324252627282930313233Security CodeNAME ON CARD *FirstLastBILLING ADDRESS *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryPreviousMessageSubmit