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Adult Class Registration Form & Health Waiver

Integral Ballet
1842 Merrick Road | Merrick NY 11566

http://www.adultballetlongisland.com

516-442-1590

PLEASE NOTE The front desk will only be informed that your registration form has been submitted when a tuition payment is made. Completing an online registration form does not hold your spot in class unless a tuition payment is received.

Registration form and payment must be received at least 72 hours before attending class. Please read the withdrawal policy before making your tuition payment.

Participant Information

First Name *

Last Name *

Birth Date *

Class Title, Level, Day & Time (For Example: Ballet Level 1, Tuesday 5pm) *

Please confirm the number of classes for which you are enrolling: *

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Relationship to Participant *

Participant Address 1 *

Participant Address 2

City *

State *

Zip *

Phone *

Alternate Phone

Email Address Where All Class Related Information Can Be Sent (including weather cancellations etc) *

TUITION & REGISTRATION TERMS

Registration fees and tuition paid are NON-REFUNDABLE and NON-TRANSFERABLE regardless of attendance.

There is a $12 registration fee per registration. It is included in the tuition rate listed on our website. Adult students enrolling for a year-in-full pay a single registration fee.

Year in full tuition is based on a single calendar year begining with our Summer 1 session and ending with our Spring 2 session.

Tuition cannot be pro-rated for absences or late registration.

Yearly tuition is payable as a single payment by cash, check or credit card (4% service fee will be added for credit cards).

There is a $20.00 Service charge for any cards we are unable to process for monthly billing. There is a $20.00 Service charge for all checks returned unpaid by the Bank.

All 1.5 hour, 1 hour, 45 minute classes and pointe classes are charged the same as the hourly rate.

Classes with fewer than 5 students are subject to shortening.

There are no refunds for missed lessons. All school breaks: February break, Spring break, Early summer break, Late summer break and Christmas break have been considered in our pricing. Absences and planned/unplanned closures have also been considered.

The adult class schedule is subject to change within a given calendar year.

We are unable to guarantee make up lessons for missed adult classes. Make-ups are permitted in other adult classes of appropriate level, during the same six week series in which class was missed, only when there is room in other classes.

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I have read, understood and am in agreement with the Tuition & Registration Terms as listed above. *

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Class Attire

We recommend a form-fitted leotard and tights for dance classes. Dancers may wear dance skirts, athletic shorts, leg warmers and other dance-appropriopriate accerssories as well. Form fitted athletic attire is also permissible as long as the teacher can clearly see your form and alignment.

For safety, it is recommended that dancers pull long hair back away from their face and do not wear loose or hanging jewelry.

Ballet class: canvas or leather split or full sole ballet slippers in any color

Tap: flat or heeled tap shoes in any color

PBT: barefoot or barre socks

Bellydance: barefoot or ballet slippers

Hip Hop: indoor-only clean sneakers

Jazz: Low or ankle jazz boots, ballet slippers or freeform shoes

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My electronic signature below indicates that I have read, understood and agree with the Class Attire terms as listed above. *

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Studio Rules

Trial/placement periods are available as outlined on the tuition schedule. Integral Ballet reserves the right to drop registrants from enrollment without refund due to nonpayment, disruptive behavior, excessive absences, or improper attire. Classes with five or less students are subject to shortening. Class and level placement is at the discretion of Integral Ballet staff only.

Family and friends are not permitted in studio unless invited and announced.

Students must leave on time after class.

I acknowledge that I will not receive compensation for any published photographs taken at Integral Ballet or events hosted by Integral Ballet. I authorize Integral Ballet to publish photographs taken of me for publicity purposes. Integral will always ask permission for published photos on social media and advertising outlets.

I have read, understood and am in agreement with all of the information contained in this form. I attest that I am in good health to participate in dance and movement classes at Integral Ballet. I hold Integral Ballet, its teachers, staff and school, harmless for any and all injuries arising out of participation in any class(es) or other related activities away from the school. In such event, I further agree that the cost of such medical services shall be borne exclusively by myself. I hereby authorize Integral Ballet to take any necessary steps to make medical attention available, including physicians, hospitals or any other medical services, and Integral Ballet shall have full discretion to make such a decision.

I have read, understood and am in agreement with the Studio Rules as listed above. *

I explicitly understand and agree to the foregoing terms as well as the amount of tuition as listed above. My affixed electronic signature has the same legal force and effect as my handwritten signature. *

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