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816.931.8993
11 am – 4 pm, Mon – Fri

Buy Online

Email Box Office

  • Plan your visit
  • Discover
  • Community
  • Support
  • Connect
  • Resources
  • School
  • 2020-2021 Cancellations
  • All Performances & Events
  • Subscriptions
  • Parking
  • Pre-Performance Programs
  • Seating Charts
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  • Meet the Dancers
  • Bolender Center
  • Company Auditions
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    • Lecture Demonstrations
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2021 R.O.A.D. Scholarship Registration

R.O.A.D. Scholar Families - Please fill out this form to submit your registration for the 2021 R.O.A.D. Scholarship Program. Please complete all pages by January 31, 2021 and submit.

Enrollment is for January - July 2021 at the Bolender Center and virtual.

Step 1 of 5

20%
  • STUDENT INFORMATION

  • Please enter a number from 2 to 21.
  • PARENT/GUARDIAN 1 INFORMATION

    Parent/Guardian 1 will be used as the PRIMARY and first contact for the student(s).
  • This email will be used for all KCBS communication as the student's primary contact.
  • This phone number will be used as the primary contact for the student.
  • PARENT/GUARDIAN 2 INFORMATION

    Parent/Guardian 2 will be used as the secondary point of contact for the enrolled student(s).
  • HEALTH INFORMATION

  • In the event of an emergency, we will first contact the parent/guardians. In the event that parent/guardians cannot be reached, please contact:
  • Please indicate any of the following conditions which have applied or currently apply to the student.
  • Please upload a photo or scan of the front AND back of the student's medical insurance card.

    If you are unable to upload a photo of your student's medical insurance, please email a copy to education@kcballet.org
    Drop files here or
    Accepted file types: jpg, png, pdf.
  • WAIVER AND RELEASE

  • Liability Release

    As the enrolled participant and/or the parent/guardian of the participant, I agree and understand that dance/ 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 and the R.O.A.D. Scholarship Program. 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 and the R.O.A.D. Scholarship Program. 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 and/or any other reason deemed appropriate by the School Director and the Community Engagement and Education Manager.

  • 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.
  • ADDITIONAL INFORMATION

  • Please select one.
  • What influenced you to enroll your child in the R.O.A.D. Scholarship Program? Please select one.
  • FOR ALL STUDENTS

    For grant purposes we appreciate you responding to the following demographic questions. This information will remain confidential for each individual family.
  • What race/ethnicity do you identify with?
  • What race/ethnicity do you identify with?
  • What race/ethnicity do you identify with?
  • ENGAGE WITH KANSAS CITY BALLET!

  • DANCEWEAR

  • Please select one
  • Please select one
  • Please select one
  • Please select one
  • R.O.A.D. Scholar Girls will wear:
    • Royal Purple short-sleeved leotard
    • Pale pink convertible tights
    • Pink Canvas full sole ballet shoes
    • Hair pulled back neatly into bun
    • No jewelry please
  • R.O.A.D. Scholar Boys will wear:
    • White T-shirt
    • Black Biker Shorts
    • White ballet shoes
    • White socks

Todd Bolender Center for Dance & Creativity

500 W Pershing Rd Kansas City MO 64108

 

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