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

2022 KCBS Fall Prep Registration

Please complete this form to submit your registration for the 2022 Fall Prep Program. Submission of form and payment is NOT confirmation of registration - an enrollment confirmation email will be sent once your spot is secured. Please allow five (5) to ten (10) business days for our staff to process the registration.

Step 1 of 6

STUDENT INFORMATION
Student Name*
First Last
Preferred First Name for Roster
If nothing is entered here, we will use the First Name listed above.
Pronouns*
Date of Birth*
Age 8/15/2022*
Please enter a number from 10 to 21.
Student 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.
Student's Email
Please provide your student's email.

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 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
- Mobile
- Home
- Work

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

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

The Kansas City Ballet School (KCBS) has created Safety Guidelines for the return to classes and workshops from July 2020 through the 2022-2023 Academic Year. The attached guidelines were prepared in consultation with medical experts, the Center for Disease Control and Prevention (CDC), and state and local officials on the opening of schools, as well as our own research in our particular field for operation, including in consultation with our colleagues from dance schools across the nation.

Kansas City Ballet has put into place these preventive measures in an effort to reduce the likelihood of the spread of COVID-19; however, even if these procedures are strictly followed, KCBS cannot guarantee that you or your child (the “Student”) will not become infected by 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. 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 understand that KCBS will try to follow the Safety Guidelines referenced above, but I also understand that I cannot expect perfect compliance. I acknowledge and understand that, even if there is strict adherence to the procedures referenced above, there is still a risk that my child attending the Program can contract COVID-19 while on Kansas City Ballet School premises. I also acknowledge that due to their physical nature, dance programs may carry a greater risk than other activities of exposure to COVID-19. Even when all reasonable precautions are taken, there is an unavoidable risk of exposure to COVID-19.
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.
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.
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). 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. 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 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.

Dance Day
This year we would like to invite all dancers who are participating in our Fall Prep classes to perform at the 2022 KC Dance Day. Saturday, August 27 will be KCB's 12th annual celebration of dance and movement featuring FREE dance performances.

We would love to have your student participate in showcasing our School.
Dance Day Agreement*
Dancers participating in Dance Day are required to attend both weeks of the Fall Prep course.
Dancers will have rehearsal every night Monday - Thursday 8:00-8:30pm following their Fall Prep Classes.
There is no cost to participate in Dance Day.
Dancers must commit to all rehearsals to participate in the Dance Day performance on Saturday, August 27.
Dancers will wear their KCBS uniform leotard for the Dance Day Performance.
- My student will participate in KC Dance Day 8/27.
- My student will NOT participate in Dance Day.
Please only push submit ONCE. The page should refresh when the form has been summitted. A confirmation email will be sent to you if the form has been properly submitted.

Box Office

2022 KCBS Fall Prep Registration

Step 1 of 6

STUDENT INFORMATION

PRIMARY PARENT/GUARDIAN INFORMATION

HEALTH INFORMATION

CLASS ENROLLMENT INFORMATION

PAYMENT INFORMATION

WAIVER AND RELEASE

Dance Day

Contact US

Box Office