Enrollment Application (Adult Introduction to Ballet)

1Student Information

2Demographic Survey

3Enrollment Agreement

4Class Selection and Tuition

STUDENT INFORMATION

NAME *

First

Last

BIRTHDATE *//

Select one: *

New student
Returning student

ADDRESS *

Address Line 1

Address Line 2

City

State

Zip Code

PHONE *

EMAIL *

Confirm Email

ADDITIONAL INFORMATION

Is 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? *

EMERGENCY CONTACT

NAME *

First

Last

RELATIONSHIP *

PHONE *

DEMOGRAPHIC SURVEY

Diversity 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):

White
Black
Asian
Hispanic
Pacific Islander
Native
Other

Please specify

The primary language spoken in my home is:

English
Spanish
French
Amharic/Ethiopian
Chinese/Mandarin
Swedish
Hebrew
Turkish
German
Italian
Farsi
Arabic
Japanese
Portuguese
Romanian
Slovak
Russian
Patois
Creole
Other

Please specify

My household income is:

Less than $30,000
$30,000-$60,000
$60,000-$90,000
$90,000-$120,000
$120,000-$150,000
More than $150,000

What obstacles exist that prevent you from attending a José Mateo Ballet Theatre performance?

Ticket Cost
Not Interested
Child Care
Location of Theatre
Not enough time
None, I attend JMBT performances

My neighborhood (i.e., Winter Hill, Inman Square, Beacon Hill, Hyde Square, etc.) is:

ENROLLMENT AGREEMENT

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.

Signature

Date: 07/06/2022

CLASS SELECTION

INTRODUCTION TO BALLET LEVEL *

SESSION *

Current session: 3/14/22–4/13/22
Session 1: 4/18/22–5/18/22
Session 2: 5/23/22–6/27/22 (no class 5/30/22)
Session 3: 6/29/22–8/3/22 (no class 7/4/22)

SESSION *

Current session: 3/15/22–4/14/22
Session 1: 4/19/22–5/19/22
Session 2: 5/24/22–6/23/22
Session 3: 6/28/22–7/28/22

TUITION

Tuition

Price: $ 150.00

Upon clicking "SUBMIT" below you will be taken to another page to complete your payment.

Adult Introduction to Ballet

Enrollment Application