2017 SUMMER DANCE PROGRAM NEWTON REGISTRATION AGREEMENT

Transcription

1 Student ID: (Office use only) Parent ID: (Office use only) 863 Washington Street, Newtonville, MA SUMMER DANCE PROGRAM NEWTON REGISTRATION AGREEMENT This form must be accompanied by or include: 1. $ check or money order ($55.00 registration fee and $ non-refundable deposit) 2. Photo submission via (see Section C) 3. Appropriate signatures (see Section G) 4. Signed Cell Phone Policy and Agreement form (see included form, residential students only) This form must be fully completed, signed, and accompanied by the appropriate documents to be considered valid. Incomplete registration agreements cannot be considered. Please select one: Residential student Commuter student $5, ($55.00 registration fee; $2, tuition; $2, room & board) $3, ($55.00 registration fee; $2, tuition) A. Student Information Last name: First name: Middle name: Address: City: State: Zip: Student cell phone: Gender: Male Female of birth: Student Country of citizenship: English proficiency for international students (please select current level): Beginner Average Fluent Residential students, list any dietary restrictions (vegetarian, vegan, gluten free, allergies, etc.): B. Parent/Guardian Information Please provide complete legal name(s). No nicknames please. Name 1: Mr. / Mrs. / Ms. Primary billing contact? Legal guardian? Yes No Name 2: Mr. / Mrs. / Ms. Primary billing contact? Legal guardian? Yes No Address: Address: City State Zip City State Zip Work phone: Cell phone: Work phone: Cell phone: C. Photo Submission Submit one (1) photo of your student via to SDP@bostonballet.org with SDP ID Photo Submission and your child s name in the subject line. This photo will be used to create a Boston Ballet ID for your student. Photo should be a recent, passport-style photo (front facing, head and shoulders only) taken in front of a white or neutral background. Please include the following in your student name, age as of the first day of SDP, Residential or Commuter, and student account number. RCVD DATE: RVCD BY: HH: PP: F B JJ: ORD: SC: QC: Page 1 of 4

2 D. Additional Emergency Contact All attempts will be made to contact the student s parent/guardian first. Name: Relationship to student: Cell/work phone: E. Health Insurance If you have health insurance, please complete the following information. In the event that you need medical care, this will expedite the administrative process. Name of company issued by: Health insurance policy number: Group number: Circle whether you are covered under a: Family policy Individual policy If family policy, policy holder s name: Policy holder s date of birth (mm/dd/yyyy): Health insurance company address: Health insurance company phone number: If you do not have health insurance, please fill out the following: Due to the fact that we/i do not have medical insurance for: Student name (print) we/i will assume all responsibility for payment(s) of medical treatment if an injury does occur while he/she is a student of Boston Ballet School. Boston Ballet School will not be responsible for any medical costs. Parent or guardian name (print) Signature F. Payment This form must be accompanied by a $ non-refundable deposit ($55.00 registration fee and $ deposit applied toward tuition) or you can choose to pay in full. Please refer to the Payment Schedule page (Page 5 of this form) for payment details. Payment by Credit Card Cardholder s Name: Card number: Expiration: Amount: Please check here to select the Automatic Credit Card Option. The non-refundable installment plan fee is waived for families selecting the Automatic Credit Card Option upon registration only. The Automatic Credit Card Option will be cancelled for any credit card that declines for any reason. Payment by Cash / Check / Money Order (please circle) Please make your check or M.O. payable to Boston Ballet School. Page 2 of 4

3 G. Terms The above information I have supplied is true and correct to the best of my knowledge. If any information is found to be false, it will be cause for my student s dismissal from the Summer Dance Program. I understand that Boston Ballet School (BBS) reserves the right to dismiss any student for behavior it deems inappropriate at any time, thus forfeiting my tuition and residential payments. I understand that if the faculty of BBS and supporting medical staff note a low body weight or a drastic change in a student's health during the program, BBS reserves the right to make a determination as to the student s physical risk and subsequently limit the student's participation in the program. I will provide the student s birth certificate upon request. I agree to pay the final tuition and residential payments, in full, and understand that I am not entitled to a refund if I choose not to attend the program. Refunds are granted only to those who do not attend the program due to a medical reason. To obtain a refund once the program has begun, Boston Ballet must receive signed documentation from a Boston physician stating the student is unable to continue participation in the program because of an injury. This documentation must be received at our 19 Clarendon Street office prior to the close of the session (July 29, 2017). Documentation sent after the program has ended will jeopardize a refund. All refunds will be issued at the end of the program. I agree that I will not hold the Boston Ballet or any of its agents (BBS, Boston Ballet or any faculty member or employee of either) liable for injuries sustained, illnesses contracted, or responsible for any article lost or stolen while my student is at BBS, except in the case of proven negligence. I agree to abide by the rules and regulations of this program. I hereby irrevocably consent to and authorize the use and reproduction by BBS, or Boston Ballet of any and all photographs, recordings, videotapes and/or other reproductions of likenesses of the students person of characteristics ( reproductions ) which have been secured by or for Boston Ballet, for any purpose whatsoever, without compensation to the student. All reproductions shall constitute the property of Boston Ballet, or others authorized by it, to exhibit, broadcast, and/or distribute or otherwise further reproduce said reproductions in whole or in part over in any medium whatsoever, including, without implied limitation, newsletters, magazines, radio, newspapers, closed circuit television, film, cable, and television, with or without compensation in perpetuity. I also release, discharge, and agree to hold harmless the producers or any persons or entities, acting under their permission or authority from any liability arising from the use of said reproductions. In addition to the above policy statements and waiver of liability, I, as parent or guardian of the applicant, understand that I will be contacted in the event of a medical emergency. An administrator of BBS or appointed representative will sign for care if I cannot be reached. I hereby authorize medical care under those circumstances. I shall indemnify, hold harmless and defend Boston Ballet, its officers, boards, agents, servants and employees except in the case of willful negligence or misconduct on their part against any and all claims, actions, or suits brought for damages or alleged damage, and from all liability, loss and expense, including reasonable legal expenses, resulting from any injury to person or property from loss of life sustained by myself or my child while I or my child is a participant in Boston Ballet classes or activities, while on or about Boston Ballet, Lasell College, or Boston University premises, or while in transportation provided by Boston Ballet to or from Boston Ballet classes or activities, or medical appointments. I understand that in signing this Registration Agreement, I am agreeing to accept the guidelines of the Boston Ballet School. I have read and agree to the above policy statements and waiver of liability. I grant permission for my student Student name (print) to participate in this program. Signature of parent or guardian (or person financially responsible for student) BBS admits students of any race, color, national, and ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at the school. Page 3 of 4

4 19 Clarendon Street Boston, MA CELL PHONE POLICY AGREEMENT FOR RESIDENTIAL STUDENTS Boston Ballet s Summer Dance Program is an opportunity for students to immerse themselves in an environment that focuses on their ballet training. Students selected for this program are expected to demonstrate an independence that allows them to focus on their dance education. In an educational setting, cell phones and access to social media serve as distractions from this focus, and prevent students from forming trusting relationships with their peers, staff and faculty. The cell phone policy, outlined below, is in place to help students to disconnect from the digital world and make connections with teachers, staff, and other students, enhancing the experience for everyone. Be assured that in an emergency, SDP staff members are on hand to facilitate student/parent communication. Parents are notified of any emergencies or situations where parent involvement is necessary. We ask parents to join us in teaching students the importance of this policy and promoting a safe, healthy, and fun experience at Boston Ballet School s Summer Dance Program Cell phone use will be limited to Saturdays and Sundays between the hours of 8:00am and 10:00pm EST. All cell phones will be collected by residential staff, who will distribute them to students during the regulated hours. This policy extends to and includes the use of tablets and other devices with the ability to text, , or to conduct communication outside of the regulated hours. This policy is put in place with these goals in mind: Create a trusting relationship between students and staff Enable staff to respond to issues in a fast and direct way Streamline communication in order to ensure safety Encourage independence by teaching students to solve their own challenges Discourage incidents of cyber bullying and miscommunication Direct students focus to their dance training Foster healthy social interactions with peers and create positive relationships that can last a lifetime Agreement: We,,, as student print student s name print parent/guardian name and parent/guardian, have read and understand the cell phone policy listed above, and agree to abide by this policy. We understand that disciplinary action will be taken if this policy is violated. Student Signature Parent Signature This signed agreement must be submitted with your registration agreement in order for your registration to be processed. Page 4 of 4

5 19 Clarendon Street Boston, MA SCHEDULE OF PAYMENTS Due to the high demand and limited capacity of this program, all students must adhere to a strict payment schedule. Payment deadlines cannot be extended. Students whose payments are not received on time may forfeit their spot in the program to a student on a waiting list. Please keep this payment schedule in mind when registering for the program. The schedule of all forms and payments for Summer Dance Program is detailed below. Payments may be made in full, or according to the payment plan. For online registrations: the deposit and all other payments is payable by credit card only. For paper registrations: the deposit is payable by credit card payment, check or money order, all other payments may be made by check, money order or credit card. INITIAL DUE DATE: The due date for these registration materials varies depending on your audition date. Please see acceptance for your initial due date. Registration: DUE MARCH 10, 2017: $ non-refundable deposit ($55.00 registration fee and $ deposit applied toward tuition) Registration Agreement (completed and signed) ID photo submission via (see Registration Agreement for details) Optional: DUE MARCH 31, 2017: First payment: DUE April 21, 2017: Second payment: Financial Aid Application For form and instructions, please SDP@bostonballet.org 50% of total amount due, after initial deposit Residential Student $ Commuter Student $1, % of total amount due, after initial deposit Residential Student $ Commuter Student $ DUE May 12, 2017: Final payment: 20% of total amount due, after initial deposit Residential Student $ Commuter Student $ Supplemental forms: Student handbooks and supplemental registration forms will be sent in mid-april. Details on program, rules, weekend activities, merchandise, roommates, travel plans, and more will be included. Medical information: Required medical forms must be completed by student s parent/guardian AND physician. Tuition and Room & Board Payments: Residential Student: $2, (tuition), $2, (room and board), $55.00 (registration fee) Total Cost: $5, Commuter Student: $2, (tuition), $55.00 (registration fee) Total Cost: $3, Payments must be received no later than the indicated due dates; a $25 late fee will be assessed for each late payment. For paper registrations: if you would like your credit card to be automatically charged on each of the three due dates, please indicate this on the first invoice you receive. American Express, Visa, Discover, and Master Card are accepted. Checks must be made out to Boston Ballet. If a payment by check is returned because of insufficient funds, a $50 returned check fee will be assessed and the balance due will be required by money order or credit card. A bounced check is considered to be a late payment and may jeopardize the student s place being held in the program. FINAL PAYMENTS MUST BE RECEIVED IN FULL BY Friday, May 12, Page 5 of 4