Name: KC Ballet
Address: 500 W Pershing Rd, Kansas City, MO, 64108, United States
Telephone: 8169318993

2023-2024 KCBS Winter Camp Registration

Please complete this form to submit your registration for the 2023-2024 Winter Camps. Submission of form and payment is NOT confirmation of registration - an enrollment confirmation email will be sent once your spot is secured. Please allow up to ten (10) business days for our staff to process the registration.

Step 1 of 5

STUDENT INFORMATION
Student Name*
First Last
Preferred First Name for Roster
If nothing is entered here, we will use the First Name listed above.
Preferred Pronouns*
Please enter any and all pronouns your dancer uses
Date of Birth*
MM slash DD slash YYYY
Age as of 12/1/2023*
Please enter a number from 2 to 21.
Primary Contact Email*
This email will be used for all KCBS communication as the student's primary contact.
Student Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Student Email
Please provide your student's email if your student is age 16+.

PRIMARY PARENT/GUARDIAN INFORMATION
The information listed below will be used as the PRIMARY and first contact for the student(s).
Primary Parent/Guardian Name*
First Last
Primary Parent/Guardian Relationship to Student*
- Mother
- Father
- Guardian
Does Primary Parent/Guardian have the same address as the student?*
- Yes
- No
Primary Parent/Guardian Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Email*
This email will be used for all KCBS communication as the student's primary contact.
Primary Phone*
This phone number will be used as the primary contact for the student.
Alternate Phone
If entering an alternate phone, please select below the type of phone number.
Alternate Phone Type
- Home
- Mobile
- Work

WAIVER AND RELEASE
Please read carefully before signing. This is a release of liability and waiver of certain legal rights.
LIABILITY RELEASE

As the enrolled participant and/or the parent/guardian of the participant, I agree and understand that dance/fitness training is a potentially hazardous activity. I recognize that there are risks inherent in dance training including but not limited to serious physical injury. The participant hereby agrees to participate in activities of the Kansas City Ballet School (KCBS) and hereby agrees to indemnify and hold harmless KCBS, its instructors, officers, directors, agents and employees against any liability resulting from any injury that may occur to the participant while participating in activities of KCBS. The participant also agrees to indemnify KCBS for any damages incurred arising from any claims, demand, action or course of action by the participant. The participant authorizes any representative of KCBS to have the participant treated in any medical emergency during their participation in activities of KCBS. Further, the participant and/or parent/guardian agrees to pay all costs associated with medical care and transportation for the participant. Any medical/health issues of which the staff should be aware are disclosed on the Health History Form. The parent/guardian will keep KCBS informed of any changes in the participant’s health.

PHOTOGRAPHY/VIDEOGRAPHY/SOCIAL MEDIA RELEASE

As the enrolled participant and/or the parent/guardian of the enrolled participant, I authorize Kansas City Ballet and/or its representative, agent or employee to photograph and/or videotape and use any photograph/likeness of me or my minor child for any purpose, including publicity, choreographic archives, promotional materials, KCB social media, and/or any other reason deemed appropriate by the School Director.
Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

By signing this release, you acknowledge your child’s risk of being exposed to or infected by COVID-19 by attending any class held at the Bolender Center for Dance & Creativity or the South Campus of Kansas City Ballet School. This exposure may result from the actions, omissions, or negligence of Kansas City Ballet, Kansas City Ballet School, and others, including but not limited to, faculty, staff, and class participants and their families, or from circumstances which are unknown or beyond anyone’s control.

READ CAREFULLY AS EXECUTION OF THIS FORM WILL WAIVE LEGAL RIGHTS:

By signing below, you acknowledge that:

I knowingly and voluntarily agree to assume all the risks of COVID-19 and accept sole responsibility of any infection (including but not limited to personal injury, disability, and death) or expense of any kind, that I or my child may experience or incur arising from my child’s attendance at Kansas City Ballet School classes and workshops or use of Kansas City Ballet School facilities or other participation in Kansas City Ballet School programs.

In consideration of the acceptance of Student for participation in a KCBS program, Student and his/her assignees, heirs, parents, guardians, and legal representatives hereby voluntarily release, forever discharge, and hold harmless Kansas City Ballet, Kansas City Ballet School, and each of their officers, trustees, employees, faculty, staff, students, agents, representatives, or groups affiliated therewith (collectively “the Kansas City Ballet Releasees”) from any liability, claims, or causes of action of whatever nature, arising from or related to exposure to COVID-19 for any reason whatsoever to the fullest extent permitted by law, including without limitation claims based on the actions, omissions or negligence of any of the Kansas City Ballet Releases or claims arising out of Student’s attendance at Kansas City Ballet School classes and workshops or use of Kansas City Ballet School facilities or other participation in Kansas City Ballet School programs.

I acknowledge by signing this release that I have read and understand the KCBS Safety Guidelines and Protocols. I also understand that my assumption of risk and release of claims applies, without limitation, to any COVID-19 infection (whether it occurs before, during, or after participation in classes or workshops or other programs). By signing this document, Student and his/her assignees, heirs, parents, guardians, and legal representatives waive the right to bring any legal action now or at any time in the future to recover compensation or obtain any other remedy for any injury to Student or Student’s property—including his/her death—caused by COVID-19 or COVID-19-related procedures and arising out of his/her participation in classes or workshops or use of Kansas City Ballet School facilities or participation in any program of the KCBS. I also understand that the Student will not be accepted into the program unless this document is signed with acknowledgement of understanding of the risks involved.

In addition, I understand that this release is intended to be as broad and inclusive as the State of Missouri will allow and that if any portion is held invalid, agrees that the balance shall, not withstanding, continue in full force and effect.

By signing, I acknowledge and represent that I am authorized to execute the Assumption of Risk and Waiver of Liability with reference to the Students whose name(s) I have listed below. I understand and agree that this Assumption of Risk and Waiver of Liability is applicable to all Students listed, below, and to every Kansas City Ballet School class or workshop or program attended by any such Student after the date I sign this document.
Parent/Guardian Signature (Or Student If 18 or Older)*
By printing my name below, I acknowledge that I have read the above Liability Waivers, Photography/Videography/Social Media Release, and Health and Safety Protocols and sign with the full knowledge of their content and significance. Both parties agree that a printed name is the legal equivalent of a manual/handwritten signature on this form.

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2023-2024 KCBS Winter Camp Registration

Step 1 of 5

STUDENT INFORMATION

PRIMARY PARENT/GUARDIAN INFORMATION

HEALTH INFORMATION

CLASS ENROLLMENT INFORMATION

Payment Information

WAIVER AND RELEASE

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