STUDENT INFORMATION

Student Name*

First Last

Preferred First Name for Roster

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

Gender*

Male

Female

Date of Birth*

PRIMARY PARENT/GUARDIAN INFORMATION

The information listed below will be used as the PRIMARY and first contact for the student.

Primary Parent/Guardian Name*

First Last

Primary Parent/Guardian Relationship to Student*

Mother

Father

Guardian

Other

Does the 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

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.

Parent/Guardian Signature*

By printing my name below, I acknowledge that I have read the above Health and Safety Protocols, Liability Waivers, and Photography/Videography/Social Media Release 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.

Submit Registration

Please only click submit ONCE. The page should refresh when the form has been submitted. A confirmation email will be sent to you if the form has been properly submitted.

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Spring 2025 Jazz & Tap Workshop for Ages 5-7 Registration

STUDENT INFORMATION

PRIMARY PARENT/GUARDIAN INFORMATION

HEALTH INFORMATION

PAYMENT INFORMATION

WAIVER AND RELEASE

Submit Registration

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