TEENAGER’S INTRODUCTION TO BALLET – CAMBRIDGEENROLLMENT APPLICATIONPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.1Student and Parent/Guardian Information2Demographic Survey3Agreements4Level Selection and Tuition/Financial AidSTUDENT INFORMATIONNAME *FirstLastSelect one: *New studentReturning studentLayoutDATE OF BIRTH *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920GRADE *GENDERHOME ADDRESS *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHOME PHONE *LayoutSCHOOL *CITY *STATE *DANCE SCHOOL *José Mateo Ballet TheatreOther dance schoolNo previous dance experienceLayoutSCHOOL NAME *CITY *STATE *PARENT/GUARDIAN I INFORMATIONNAME *FirstLastADDRESS *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLayoutCELL PHONE *EMAIL *LayoutWORK PHONE *EMPLOYER *Would you be interested in volunteering with José Mateo Ballet Theatre?YesNoPARENT/GUARDIAN II INFORMATIONNAMEFirstLastADDRESSAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLayoutCELL PHONEEMAILLayoutWORK PHONEEMPLOYERWould you be interested in volunteering with José Mateo Ballet Theatre?YesNoEMERGENCY CONTACT(other than Parent/Guardian)NAME *FirstLastRELATIONSHIP *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: *Best person(s) to contact regarding attendance or other notices:LayoutNameRelationPhoneLayoutNameRelationPhoneNextDEMOGRAPHIC 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 specifyYour 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 performancesYour neighborhood (i.e., Winter Hill, Inman Square, Beacon Hill, Hyde Square, etc.) is:PreviousNextENROLLMENT AGREEMENTI hereby enrollStudent Namein José Mateo Ballet Theatre’s Teenager’s Introduction to Ballet course.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 the student, for whatever reason, be unable to participate, withdraw from the program, be dismissed with cause, or be absent from the program, payment 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. 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 information.LayoutParent/Guardian SignatureDate: 12/03/2023ATTENDANCE AND PARTICIPATION AGREEMENTJosé Mateo Ballet Theatre Teenager’s Introduction to Ballet 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 two times or have more than one unexcused absence 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.LayoutStudent SignatureParent/Guardian SignatureDate: 12/03/2023PreviousNextSESSION *Session 1: 9/14/23-11/16/23Session 2: 1/4/24-3/14/24 (no class 2/22/24)Session 3: 3/21/24-5/30/24 (no class 4/18/24)Are you applying for financial aid? *YesNoFINANCIAL AID APPLICATION MATERIALSTax DocumentsPlease 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. Click or drag files to this area to upload.You can upload up to 10 files. StatementsStatement 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 at the beginning of this form *TuitionPrice: $ 175.00PAYMENT 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 IslandsCountryPreviousPhoneSubmit