Step 1 of 4

25%

STUDENT INFORMATION

Student Name*

First Last

Preferred Name for Name Tag/Roster

If nothing is entered here, we will use the First Name listed above.

Date of Birth*

MM slash DD slash YYYY

Age (as of 6/2/25)*

Gender*

Student Address*

Street Address Address Line 2 City State ZIP Code

PARENT/GUARDIAN 1 INFORMATION

Parent/Guardian 1 will be used as the PRIMARY and first contact for the student(s).

Parent/Guardian 1 Name*

First Last

Parent/Guardian 1 Relationship to Student*

Mother

Father

Guardian

Other

Does Parent/Guardian 1 have the same address as the student?*

Yes

Parent/Guardian 1 Address*

Street Address Address Line 2 City State ZIP Code

Parent/Guardian 1 Email*

This email address will be used for all JSI communication.

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

PARENT/GUARDIAN 2 INFORMATION

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

Parent/Guardian 2 Name

First Last

Parent/Guardian 2 Relationship to Student

Mother

Father

Guardian

Other

Does Parent/Guardian 2 have the same address as the student?

Yes

Parent/Guardian 2 Address

Street Address Address Line 2 City State ZIP Code

Parent/Guardian 2 Email

Parent/Guardian 2 Primary Phone

This phone number will be used as the primary contact for the student.

Parent/Guardian 2 Alternate Phone

Parent/Guardian 2 Alternate Phone Type

Mobile

Home

Work

Health Information

Emergency Contact (other than parent/guardian)*

In the event of an emergency, we will first contact the parent/guardians. In the event that parent/guardians cannot be reached, please contact:

First Last

Emergency Contact Relationship to Student*

Grandparent

Aunt/Uncle

Sibling

Neighbor

Friend

Other

Emergency Contact Phone*

Emergency Contact Email*

Health Conditions*

Please indicate any of the following conditions which have applied or currently apply to the student.

Asthma

Behavioral/emotional

Bleeding disorder

Chronic illness

Diabetes

Disordered eating

Epilepsy/seizures

Fainting/dizziness

Gastrointestinal issues

Headaches

Heart problems

Hospitalization

Mononucleosis

Surgery

Other

None

Please explain any items checked above:*

Allergies*

Environmental

Food

Medication

Seasonal

Other

None known

Please list all known allergies, including reaction and treatment:*

Medications*

Student does not take medication on a routine basis

Student does take medication on a routine basis

Please list medications here:*

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 Kansas City Ballet (KCB), KCBS, and the instructors, officers, directors, agents and employees of each against any liability resulting from any injury that may occur to the participant while participating in activities of the KCBS. The participant also agrees to indemnify KCB and KCBS for any damages incurred arising from any claims, demand, action or course of action by the participant.

Parent/Guardian Signature*

By printing my name below, I acknowledge that I have read the above releases 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.

PAYMENT INFORMATION

A non-refundable $250 deposit is required to reserve a place in the program. The deposit is applied toward the total tuition cost of $1,600. The balance of fees is due by May 5, 2025.

Scholarship and Financial Aid

I was awarded a merit scholarship for the 2025 Junior Summer Intensive

I was awarded financial aid for the 2025 Junior Summer Intensive

How would you like to make your deposit payment(s)?*

Pay by credit card

Will mail a check

How would you like to make the remaining payments?*

Autopay- I want KCBS to set up my card to run automatically

Self pay- I want to initiate my own payments

Which autopay plan would you prefer?*

One payment, full amount runs on 5/5

Two payments, half runs on 4/7, half on 5/5

To check if you have a card on file with KCBS visit Mindbody as the student. On the “Info” tab if you scroll to the very bottom you can view, add or update the card on file.

By selecting Self Pay, you agree to submit payment in full by the May 5, 2025 deadline. Payments may be made by mailing checks or by credit card by calling the school at 816-931-2232 x1391.

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

Please allow our staff ten (10) business days to process registration after you have submitted the form and deposits. If you have not received the enrollment confirmation email by then, please contact us at school@kcballet.org.

Box Office

2025 Junior Summer Intensive Registration Form

STUDENT INFORMATION

PARENT/GUARDIAN 1 INFORMATION

PARENT/GUARDIAN 2 INFORMATION

Health Information

WAIVER AND RELEASE

PAYMENT INFORMATION

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

Contact US

Box Office