NORTHWEST ARKANSAS CONSERVATORY of CLASSICAL BALLET SUMMER HEAT 2018! Registration

NORTHWEST ARKANSAS CONSERVATORY OF CLASSICAL BALLET SUMMER HEAT 2018! Registration

Name: ______Age: ______Phone#______Cell#______

Address:______EmailAddress:______

TUITION BREAKDOWN:

Class Day/Time Instructor Class Pass #Pd Ck#/CASH

How did you hear about us? ______

Class passes allow the student to attend 5 classes during the 8-week Summer Heat session (June 19-Aug 9). Please make note of the six weeks during which classes will be held. Class pass punches are ONLY valid during summer 2018, and are non-transferable to the Conservatory’s school year program or any subsequent summers. No refunds will be given for unused punches.

Adult Student/Parent Signature______Director/School Principal Approval ______

WAIVER/LIABILITY:

I understand that the instruction offered by The Northwest Arkansas Conservatory of Classical Ballet in which my child/self is participating, involves risks of accident and/or injury. Understanding those risks, I personally, as parent or legal guardian of student or adult age self, intending to be legally bound, do hereby, for myself, my heirs, executors, and administrators, waive and release The Northwest Arkansas Conservatory of Classical Ballet, all officers, representatives, successors, employees, contractors, and assigns, from any and all liability and damages for any injury, illness, or death that may be sustained by the student(s) in connection with his/her traveling to or participating in and returning from any activity or program associated with The Northwest Arkansas Conservatory of Classical Ballet, whether caused by The Northwest Arkansas Conservatory of Classical Ballet negligence, the actions of the student, or otherwise. I also understand that any other children I bring as guests are included in this waiver form.Further, I grant The Northwest Arkansas Conservatory of Classical Ballet and all employees and/or directors and faculty permission to authorize any emergency medical treatment that may be required for the student for injuries sustained during the student’s (s’) participation in the Conservatory instruction and/or performances, activities. It is understood that The Northwest Arkansas Conservatory of Classical Ballet will make an effort to contact me prior to the emergency treatment of the student(s) listed above, but that treatment by a licensed physician or medical staff person of a licensed emergency room will not be withheld if I cannot be reached. Additional emergency contact:

Name:______Phone#______Relationship to student______

PHOTOGRAPHIC/VIDEO/AUDIO/COMMUNICATION RELEASE

I authorize The Northwest Arkansas Conservatory of Classical Ballet to take and use any photographs, video or sound recordings of me/my child and any other reproductions or adaptations of me/my child’s likeness (“the material”), either in full or part, in conjunction with any wording or drawings, in a Northwest Arkansas Conservatory of Classical Ballet class, production, or presentation. I acknowledge that I have/my child has no financial/legal or royalties’ right in the material used for whatever purpose, nor in The Northwest Arkansas Conservatory of Classical Ballet class, production, presentation or any publications that includes the material. All photographs, choreography, costuming, video or sound recordings, scripts are subject to copyright laws. Any unauthorized reproduction of any kind, other than for The Northwest Arkansas Conservatory of Classical Ballet uses, will be subject to legal action.

Child’s name permitted? Yes No

Agreement signature: ______Date: ______

NWA CONSERVATORY OF CLASSICAL BALLET Princesses & Heroes Dance Camp

Name: ______Age: ______Birthdate______

Address:______Phone#______Cell#______

Food Allergies:______EmailAddress:______

Please check the session your child will be attending:

____ Dance Camp 1 June 11-15 Ages 3-5 3:30-5:00pm $85

____ Dance Camp 2 June 11-15 Ages 6-8 5:30-7:30pm $110

____ Dance Camp 3 July 9-13 Ages 6-8 3:00-5:00pm $110

____ Dance Camp 4 July 9-13 Ages 3-5 5:30-7:00pm $85

TOTAL: ______Cash ______Check#______How did you hear about us? ______

Parent Signature______Director/School Principal Approval ______Date______

Camps with fewer than 5 students enrolled will be cancelled. No refunds given unless camp is cancelled.

WAIVER/LIABILITY:

I understand that the instruction offered by The Northwest Arkansas Conservatory of Classical Ballet in which my child/self is participating, involves risks of accident and/or injury. Understanding those risks, I personally, as parent or legal guardian of student or adult age self, intending to be legally bound, do hereby, for myself, my heirs, executors, and administrators, waive and release The Northwest Arkansas Conservatory of Classical Ballet, all officers, representatives, successors, employees, contractors, and assigns, from any and all liability and damages for any injury, illness, or death that may be sustained by the student(s) in connection with his/her traveling to or participating in and returning from any activity or program associated with The Northwest Arkansas Conservatory of Classical Ballet, whether caused by The Northwest Arkansas Conservatory of Classical Ballet negligence, the actions of the student, or otherwise. I also understand that any other children I bring as guests are included in this waiver form. Further, I grant The Northwest Arkansas Conservatory of Classical Ballet and all employees and/or directors and faculty permission to authorize any emergency medical treatment that may be required for the student for injuries sustained during the student’s (s’) participation in the Conservatory instruction and/or performances, activities. It is understood that The Northwest Arkansas Conservatory of Classical Ballet will make an effort to contact me prior to the emergency treatment of the student(s) listed above, but that treatment by a licensed physician or medical staff person of a licensed emergency room will not be withheld if I cannot be reached. Additional emergency contact:

Name:______Phone#______Relationship to student______

PHOTOGRAPHIC/VIDEO/AUDIO/COMMUNICATION RELEASE

I authorize The Northwest Arkansas Conservatory of Classical Ballet to take and use any photographs, video or sound recordings of me/my child and any other reproductions or adaptations of me/my child’s likeness (“the material”), either in full or part, in conjunction with any wording or drawings, in a Northwest Arkansas Conservatory of Classical Ballet class, production, or presentation. I acknowledge that I have/my child has no financial/legal or royalties’ right in the material used for whatever purpose, nor in The Northwest Arkansas Conservatory of Classical Ballet class, production, presentation or any publications that includes the material. All photographs, choreography, costuming, video or sound recordings, scripts are subject to copyright laws. Any unauthorized reproduction of any kind, other than for The Northwest Arkansas Conservatory of Classical Ballet uses, will be subject to legal action.

Child’s name permitted? Yes No

Agreement signature: ______Date: ______

NWA CONSERVATORY OF CLASSICAL BALLET Junior Intensive June 4-8,2018

Name: ______Age: ______Birthdate______

Address:______Phone#______Cell#______

Food Allergies:______Email Address:______

Conservatory Students- Current Level at NWACCB______

New Students- Please briefly list dance experience and which studios:

TUITION: _____$135______Cash ______Check#______How did you hear about us? ______

Parent Signature______Director/School Principal Approval ______Date______

Camps with fewer than 5 students enrolled will be cancelled. No refunds given unless camp is cancelled.

WAIVER/LIABILITY:

I understand that the instruction offered by The Northwest Arkansas Conservatory of Classical Ballet in which my child/self is participating, involves risks of accident and/or injury. Understanding those risks, I personally, as parent or legal guardian of student or adult age self, intending to be legally bound, do hereby, for myself, my heirs, executors, and administrators, waive and release The Northwest Arkansas Conservatory of Classical Ballet, all officers, representatives, successors, employees, contractors, and assigns, from any and all liability and damages for any injury, illness, or death that may be sustained by the student(s) in connection with his/her traveling to or participating in and returning from any activity or program associated with The Northwest Arkansas Conservatory of Classical Ballet, whether caused by The Northwest Arkansas Conservatory of Classical Ballet negligence, the actions of the student, or otherwise. I also understand that any other children I bring as guests are included in this waiver form. Further, I grant The Northwest Arkansas Conservatory of Classical Ballet and all employees and/or directors and faculty permission to authorize any emergency medical treatment that may be required for the student for injuries sustained during the student’s (s’) participation in the Conservatory instruction and/or performances, activities. It is understood that The Northwest Arkansas Conservatory of Classical Ballet will make an effort to contact me prior to the emergency treatment of the student(s) listed above, but that treatment by a licensed physician or medical staff person of a licensed emergency room will not be withheld if I cannot be reached. Additional emergency contact:

Name:______Phone#______Relationship to student______

PHOTOGRAPHIC/VIDEO/AUDIO/COMMUNICATION RELEASE

I authorize The Northwest Arkansas Conservatory of Classical Ballet to take and use any photographs, video or sound recordings of me/my child and any other reproductions or adaptations of me/my child’s likeness (“the material”), either in full or part, in conjunction with any wording or drawings, in a Northwest Arkansas Conservatory of Classical Ballet class, production, or presentation. I acknowledge that I have/my child has no financial/legal or royalties’ right in the material used for whatever purpose, nor in The Northwest Arkansas Conservatory of Classical Ballet class, production, presentation or any publications that includes the material. All photographs, choreography, costuming, video or sound recordings, scripts are subject to copyright laws. Any unauthorized reproduction of any kind, other than for The Northwest Arkansas Conservatory of Classical Ballet uses, will be subject to legal action.

Child’s name permitted? Yes No

Agreement signature: ______Date: ______