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*

Age as of 6/6/2023*

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 ZIP Code

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

Other

Does Primary Parent/Guardian have the same address as the student?*

Yes

No

Primary Parent/Guardian Address*

Street Address Address Line 2 City State ZIP Code

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

CLASS ENROLLMENT INFORMATION

Enrollment is for the 2023 Summer Program.

June 7 - June 28, 2023

All classes will be held on Wednesdays at the Bolender Center.

Class Selection*

Please select your students age. Your students age determines your class time.

TUITION PAYMENT INFORMATION

Online registration is only accepted with payment by credit card.

Payment will be processed at the time of registration in order to reserve the student's spot.

To read more on our financial policies, please click here.

Who is responsible for payment?*

Primary Parent/Guardian

Other

Name of Person Responsible for Payment*

First Last

Phone*

Please enter the phone number of the person responsible for payment

Email*

Please enter the email of the person responsible for payment

Select Payment Method*

If selecting the card on file, you can login or create a Mindbody Account below to add or update your credit card information. Please login as the student, not the parent. Go to the info tab and scroll to the very bottom where you can view, add or update the card on file.
If you experience any trouble logging into Mindbody, please call the school at 816-931-2299 or email school@kcballet.org for assistance. Update card here.

KCBS Financial Policy Agreement*

I understand that I am enrolling my student for a class that continues through June 2023 and am liable for the tuition for the level in which my student is enrolled.

I understand that by submitting my registration online I am enrolling in autopay and authorize my credit card to be charged per the payment plan option I selected above. I will update KCBS of any changes to my card.

I understand that if I wish to withdraw my student for any reason, I must email nburkitt@kcballet.org. I understand I am liable for all tuition accrued and that future payments will only be cancelled if the withdrawal notice is received by the 1st of the month.

I understand that Kansas City Ballet School reserves the right to change the class schedule or faculty as necessary, including canceling any class that does not have a sufficient number of students enrolled.

I understand the following KCBS financial policies:
• Unsuccessful autopays will attempt to run the card on file once a day for five days. If still unsuccessful, a $15 decline fee will be charged.
• A $20 late fee may be assessed to each individual student’s account if payments are not received within five days of the scheduled due date.
• A $25 charge may be assessed for each returned check.
• Students whose accounts are deficient by two months will not be admitted to class until their account balance is paid in full.
• Tuition must be paid in full in order for students to participate in any performances.
• There are no refunds after the student’s first day of class. Extenuating circumstances such as injury or relocation may be considered.
• Transactions are non-refundable.
• KCBS does not send invoices.
• A 10% sibling discount may be applied to siblings.

Sign below to acknowledge that you have read and agree to KCBS Financial Policies.

Make A Donation Today!

Kansas City Ballet strives to provide academy classes for all students, regardless of their financial means. Please consider making a donation today to help give all students the joy of dance through our need-based financial aid fund.

YES, I would like to make a one-time donation today with my registration.

NO, I am not interested in making a donation at this time.

KCBS Donation Total

The amount below will be charged with your student's registration using the card on file. You will receive an email receipt once it has been processed.

$25

$50

$75

$100

WAIVER AND RELEASE

Please read the waivers and health and safety protocols below carefully before signing.

KCBS Health and Safety Protocols

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 Johnson County Campus of Kansas City Ballet School or by participating in any program of the Kansas City Ballet School (which programs, for purposes of this document, include residential living and social activities associated with KCBS Summer Intensive or other residential programs). 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.

STUDENT HANDBOOK AND DRESS CODE

The KCBS Student Policy Handbook and Dress Code is available on the KCBS Parent Page .

Student Handbook and Dress Code Agreement

I have read the KCBS 2022-2023 Student Policy Handbook and Dress Code and have discussed all rules and policies with my student. We agree to abide by the policies and dress code.

As a reminder, submission of this form and payment information is NOT confirmation of registration - an enrollment confirmation email will be sent once your spot is secured.

Please allow our staff 10 business days to process registration after you have submitted the form and payment. If you have not received the enrollment confirmation email by then, please contact our Adaptive Dance Coordinator at nburkitt@kcballet.org or 816-931-2299 x2.

Box Office

2023 Summer Adaptive Dance Registration

STUDENT INFORMATION

PRIMARY PARENT/GUARDIAN INFORMATION

HEALTH INFORMATION

COMMUNICATION NEEDS

CLASS ENROLLMENT INFORMATION

TUITION PAYMENT INFORMATION

WAIVER AND RELEASE

STUDENT HANDBOOK AND DRESS CODE

As a reminder, submission of this form and payment information is NOT confirmation of registration - an enrollment confirmation email will be sent once your spot is secured.

Contact US

Box Office