REGISTRATION PACKET CHECKLIST ALL DANCERS - Due March 31, 2017: Page 2 Dancer Contact Information Page 3 Session Registration Page 4 Payment Information (if enclosing payment with forms) Page 5 General Liability and Medical Waiver Page 6 Medical Information Page 7 Policy Agreements Page 8 T-Shirt Order Form Two copies of your health insurance card Signed statement on letterhead or prescription pad from your primary physician confirming that you are in good health and able to fully participate in Summer Intensive. OR Doctor s explanation of any injury, illness or other circumstance that may prevent full participation in Summer Intensive. HOUSING FORMS Due March 31, 2017 Page 11 All Age Room & Board Agreement Page 12 Age 17 & Under Roommate Request Form ADDITIONAL FORMS Due March 31, 2017: Page 13 Off Campus Housing Waiver for dancers who have arranged their own housing rental Page 14 Catered Lunch Order Form for dancers wishing to purchase lunch ALL DANCERS - Due May 1, 2017 Page 10 Transportation Form Forms must be returned via email by the appropriate due date. Submit forms and payment via email to: Summer@NashvilleBallet.com *Dancer s full name must be in the subject line* Submit payment online: http://www.nashvilleballet.com/register 1
DANCER CONTACT INFORMATION Please print legibly and provide current contact information. If the dancer is under 18, Nashville Ballet will use the parent or guardian s email address and primary phone number for all communication prior to the start of his/her session. Name: Date of Birth: Email: Male Female Mailing Address: City: State: Zip: Primary Phone : Secondary Phone: PRIMARY CONTACT FOR DANCER parent / guardian (if under 18) or emergency contact Name: Relationship to Dancer: Email: Mailing Address (if different): City: State: Zip: Primary Phone: Secondary Phone: SECONDARY CONTACT FOR DANCER alternative parent / guardian (if under 18) or emergency contact Name: Relationship to Dancer: Email: Primary Phone: Secondary Phone: 2
SESSION REGISTRATION select the session that corresponds with your acceptance letter Select Session Session Session A1 (June) June 12 to June 16, 2017 Session A1 (June) Housing and Meals June 12 to June 16, 2017 Reg. Fee* Tuition Room & Board Fee Deposit Due March 31, 2017 Final Payment Due May 1, 2017 Grand Total Grand Total After March 31, 2017 Late Registration $125 $580 n/a $290 $290 $705 $830 n/a n/a $600 $200 $400 $600 Inquire for price Session A2 (June) June 12 to June 23, 2017 Session A2 (June) Housing and Meals June 12 to June 23, 2017 Session B (July) July 10 to July 21, 2017 Session B (July) Housing and Meals July 10 to July 21, 2017 Session C (June) June 19 to June 30, 2017 Session C (June) Housing and Meals June 19 to June 30, 2017 Session D July 3 to July 21, 2017 Session D Housing and Meals July 3 to July 21, 2017 Session E June 19 to July 21, 2017 Session E Housing Only June 19 to July 21, 2017 Session E Housing & Meals June 19 to July 21, 2017 $125 $1250 n/a $625 $625 $1375 $1500 n/a n/a $1200 $400 $800 $575 Inquire for price $125 $1,250 n/a $625 $625 $1,375 $1,500 n/a n/a $1,200 $400 $800 $1,200 Inquire for price $125 $1,250 n/a $625 $625 $1,375 $1,500 n/a n/a $1,200 $400 $800 $1,200 Inquire for price $125 $1,700 n/a $825 $825 $1,825 $1,850 n/a n/a $1,750 $600 $1,150 $1,750 Inquire for price $125 $2,500 n/a $1,250 $1,250 $2,625 $2,750 n/a n/a $1,325 $500 $825 $1,325 Inquire for price n/a n/a $2,900 $1,000 $1,900 $2,900 Inquire for price Pre-Professional Session June 19 to July 21, 2017 Pre-Professional Session Housing Only June 19 to July 21, 2017 Pre-Professional Session Housing & Meals June 19 to July 21, 2017 $125 $2,500 n/a $1,250 $1,250 $2,625 $2,750 n/a n/a $1,325 $500 $825 $1,325 Inquire for price n/a n/a $2,900 $1,000 $1,900 $2,900 Inquire for price PAYMENT DUE BY March 31, 2017 - Please choose one of the following options: 3
Submit payment via credit card, check or money order with your registration forms. See next page. Pay online by visiting nashvilleballet.com/register. Scroll to find your session and click "Sign Up." Pay over the phone using a credit card. Call 615-297-2966 x 910. PAYMENT FORM - CREDIT CARD, CHECK OR MONEY ORDER INFORMATION Select your payment type: MasterCard Visa Amex Discover Money Order # Check # TODAY S PAYMENT AMOUNT: AMOUNT DUE BY MAY 1, 2017: For Credit Card Authorization: Credit Card # Exp. Date: Security Code: Billing Zip Code: Name on Card: Authorizing Signature: I hereby authorize Nashville Ballet to charge the above named card for tuition and fees for Summer Intensive 2017 as indicated above. I understand that the deposit will be charged immediately upon receipt and the final payment will be charged on or after May 1, 2017. 4
GENERAL LIABILITY & MEDICAL WAIVER Important: You are required to submit two photocopies of your health insurance card with the registration packet. Your health insurance policy must provide out of town routine and emergency care. You must purchase a temporary rider if your current coverage does not meet these requirements. Health Insurance Carrier: Mailing Address: City: State: Zip: Policy Holder: Policy Number: Name of Employer: Effective Date of Insurance: The undersigned hereby consents to medical care and treatment as deemed necessary and proper by any Nashville Ballet staff or faculty member for the above identified dancer. In the event that I cannot be contacted, I hereby authorize Nashville Ballet to then contact the secondary contact listed on page 1. In the event the undersigned parent/guardian cannot be contacted, nor the alternate emergency contact, I give permission to Nashville Ballet, or their appointed representative, to recommend a medical facility or medical professional and to authorize care. In the event of a non-emergency and medical attention is required, Nashville Ballet may recommend a medical professional to secure proper treatment. Selection and visitation of a medical professional for treatment will be the undersigned s decision. The undersigned hereby releases, discharges and forever acquits the Nashville Ballet, its respective agents, directors and employees of any and all liability, claims, demands, actions and causes of action whatsoever, arising out of or related to any loss, damage or injury, including death, that may be sustained by the undersigned or any participant in, person at, or to the property of the undersigned while either participating in or being present at the Nashville Ballet, including, but not limited to, those injuries and damages caused by negligence whether it be active or passive, or ordinary on the part of the Nashville Ballet, and its respective agents, affiliates, directors and employees arising from the undersigned while participating in or being present at the Nashville Ballet. This release shall be binding upon assignees, distributees, heirs, next of kin, executors and administrators of the undersigned and may be pled by the Nashville Ballet in any complete bar and defense against any claim, demand, action by or on behalf of the undersigned. By signing below, I acknowledge that the above dancer is physically fit and has no health, medical or physical problems that preclude his/her participation in the activities of the School of Nashville Ballet. I hold harmless the School of Nashville Ballet and the Nashville Ballet, its faculty, employees, officers and agents from any liability, actions, cause of actions, claims and demands of any and every kind which may arise from or in connection with his/her participation in these activities. By execution of this release, the undersigned hereby acknowledges and expressly represents that: he/she is duly aware of the risks and hazards inherent upon entering the Nashville Ballet/School of Nashville Ballet; he/she elects voluntarily to enter, participate or be present at the Nashville Ballet/ School of Nashville Ballet; he/she has read the foregoing release, understands it and signs it voluntarily. The undersigned is hereby bound to this agreement for the entire duration of his or her registration and/or the duration of his or her child s registration. By execution of this release, the undersigned hereby acknowledges and expressly represents that: he/she is duly aware of the risks and hazards inherent upon entering Nashville Ballet/ School of Nashville Ballet; s/he elects voluntarily to enter, participate or be present at Nashville Ballet/School of Nashville Ballet; s/he has read the foregoing release, understands it and signs it voluntarily; his/her parent or legal guardian, who is 18 years of age or older, and of sound mind, has read the foregoing release, understands it and signs it voluntarily. Dancer Signature: Date: Parent / Guardian Signature (if under 18) : Date: If you do not have medical insurance, and do not plan to purchase a policy for Summer Intensive, please initial below: 5
I do not have health insurance. I understand that I am fully responsible for any medical costs incurred. MEDICAL INFORMATION Primary Physician: Phone: Does the dancer have any medical conditions, injuries or recent surgeries that would prohibit full participation in summer intensive? Please attach a doctor s note if applicable. List any prescription medications with full name and dosage. Nashville Ballet does not dispense or administer any medications. Dancers must self administer medications. List any allergies (foods, medications, etc.) and any medications required. Other information / concerns we should know about: Your physician must provide a signed statement affirming that you are in good health and fully capable of participating in Summer Intensive. The statement may be submitted on letterhead or a prescription slip and scanned directly to our office at Summer@NashvilleBallet.com or faxed to 615-297-9972, SUBJECT/ATTN:(STUDENT NAME) - SUMMER INTENSIVE MEDICAL 6
SUMMER INTENSIVE POLICIES Nashville Ballet reserves the right to immediately dismiss any dancer whose attitude, attendance, work habits, conduct, behavior, relationships and/or interactions with fellow dancers and/or Nashville Ballet staff are deemed unacceptable by Nashville Ballet. Further, Nashville Ballet reserves the right to immediately dismiss any dancer whose conduct may be in violation of local, state, or federal laws. Boarding dancers are required to follow all regulations set forth by the university and any violation will result in immediate dismissal from the Summer Intensive. Dancers dismissed from Nashville Ballet s Summer Intensive are required to travel at their own expense. No refunds of any kind will be given. Nashville Ballet will not tolerate the presence of tobacco, illegal drugs, alcohol or the consumption of these substances at any time. No dancer shall harass or abuse any other person in word, deed or action. No dancer shall tamper with the personal property of others. Dancers over 18 with their own vehicles are not permitted to transport any dancer under 18 during the Summer Intensive. Dancers are expected to abide by any verbal or written policies made known to them during the Summer Intensive. GENERAL AGREEMENTS - Please read and initial each statement. I have received School of Nashville Ballet s Summer Intensive registration packet and understand the policies as outlined above. I agree to participate in all Summer Intensive classes, workshops, lectures, activities and sessions as indicated on the daily schedule. Exceptions will only be made in the case of injury or illness, require prior approval and must be documented by staff. I understand that failure to attend classes, workshops, lectures, activities or sessions may result in dismissal from the program at my own expense. I certify that the medical information given for the Summer Intensive dancer is a complete and accurate representation of the dancer s medical information. I understand that tuition refunds will only be considered for withdrawal due to injury or illness. Tuition refund requests after May 1, 2017 and/or before the start date of your session will not be considered. Any tuition refunds issued will not be larger than 50% of the total cost of your session. There are no refunds for registration fees, voluntary withdrawals or for room and board. All refunds will be evaluated on a case-by-case basis and will be returned no sooner than 30 days after the written request. Refunds will be issued in the same manner as the original payment. I understand that the use of illegal substances in any form will result in immediate expulsion from the program at my expense, with no refund of tuition, registration fee, or room and board fees. I give School of Nashville Ballet permission to use any film, video or still photography taken of me for promotional purposes for School of Nashville Ballet. Dancer Signature: Date: Parent / Guardian Signature (if under 18) : Date: 7
T-SHIRT ORDER FORM Summer Intensive tuition includes one summer intensive t-shirt and a key lanyard. Shirt Description: -Relaxed fit, long-sleeved t-shirts. Q T Y SIZ E D ES C RI PTION UN I T P RI CE T O T AL 1 2017 NB Summer Intensive T-Shirt Included Included ADDITIONAL SHIRT $25 ADDITIONAL SHIRT $25 1. Choose quantity and sizes. 2. Your first shirt is included in the tuition fee. Please just indicate size on the first line. No need to send any payment. 3. Any additional shirts can be purchased using the additional lines provided above. 4. Send check made payable to Nashville Ballet or include credit card information below. 5. A. Mail order form with check to: Nashville Ballet Attn: SI T-Shirts 3630 Redmon Street Nashville, TN 37209 B. Fax order form with credit card information to (615) 297-9972. 6. All orders must be received by March 31, 2017. If paying by credit card: (please circle one) AMEX Discover Mastercard Visa Name on card: CC #: Security Code: Expiration Date: Billing Zip Code: T-shirts will be available for dancers to pick up during their session. Additional shirts may be purchased while the dancer is at Summer Intensive for $25.00. Various other Nashville Ballet merchandise will be available as well. All merchandise can be purchased by cash, check or credit card. Total 8
TRANSPORTATION FORM Arrival Information: Arrival Date: Air Airline: Flight #: Arrival Time: Bus Company: Arrival Location: Arrival Time: Car: Age 17 and under drop off by parent/guardian driving self and keeping car throughout stay* * Dancers 16 and over may bring their own vehicles. Dancers are not permitted to transport any dancers under the age of 18 while attending Summer Intensive. Car: Age 18+ drop off driving self and keeping car throughout stay I would like to purchase bus transportation to and from studios - please contact me Departure Information: I am leaving immediately after my final performance on Friday evening (Session B, D, E or PP). I am leaving after my last class on Friday. (Session A or C). I am leaving on Saturday following my last day of class (Session C or D). Air Airline: Flight #: Departure Time: Bus Company: Arrival Location: Departure Time: Car pick up by parent/guardian driving self IMPORTANT Age 17 and Under: Nashville Ballet will provide shuttle service to and from the Nashville International Airport (BNA) for flights arriving and departing between the hours of 6 a.m. to 4p.m. Dancers with arrivals and departures outside of this time frame must arrange for their own transportation by cab or shuttle. Airport shuttles will be staggered in order to accommodate flight times. Dancers should be prepared to wait at the airport for a reasonable amount of time (no more than two hours) when arriving or departing. Nashville Ballet will provide shuttle service to Nashville area bus stations for dancers arriving and departing by bus. IMPORTANT Age 18 and Older: Nashville Ballet does not provide transportation for dancers age 18 and older unless purchased in advance. 9
HOUSING AGREEMENT COMPLETE IF STAYING AT BELMONT UNIVERSITY *NOTE Housing availability cannot be guaranteed after March 31, 2017.* Dancers boarding at Belmont University must sign, along with their parents or legal guardian, the Housing Rules and Regulations Contract. Parents/Guardians, please review the enclosed information with the dancer. The Rules and Regulations are enforced in conjunction with Belmont University; however School of Nashville Ballet s rules are the controlling policies. These regulations and policies are enforced for the general well-being and protection of our dancers. CURFEW: Ages 12 13 8:30 pm Sunday-Friday 9:30 pm Saturday Ages 14 17 9:30 pm Sunday-Friday 11:00 pm Saturday Ages 18 & up no curfew no curfew ROOM CHECK: Ages 12-13 9:00 pm Sunday-Friday 11:00 pm Saturday Ages 14-17 10:00 pm Sunday-Friday 12:00 am Saturday Ages 18 & up no room check no room check ACCOUNTABILITY: Dancers must be accounted for at all times and must communicate their whereabouts to chaperones by observing the School of Nashville Ballet check in/check out procedures and policies. Dancers ages 12 13 must travel with a chaperone at all times. During daytime, dancers ages 14 16 must travel in groups of 3 or more on Belmont University s campus and Hillsboro Village (neighborhood within walking distance of campus). In all other instances, dancers ages 14 16 must travel with a chaperone. Dancers age 17 must travel together in a group of 3 or more at all times. GUESTS: No members of the opposite sex are allowed in each other s rooms at any time. Fraternizing with fellow dancers is strictly prohibited. Family members are allowed to visit dancers at the dorms between 5:00 pm and curfew Monday Friday and between 1:00 pm and curfew on Saturday and Sunday. Notification must be given to chaperone in a timely manner. BEHAVIOR: Dancers are expected to conduct themselves accordingly while staying on Belmont s campus. Violation of the School of Nashville Ballet housing rules and regulations or rules of Belmont University regarding residence life or any laws of the State of Tennessee (e.g. alcohol consumption, smoking, use of illegal substances) will result in immediate expulsion with no refunds of any kind. Dancers expelled from the program who hold a scholarship will be responsible for all charges previously covered by their scholarship. I have read and understand the above rules, regulations and policies and agree to abide by them during Summer Intensive. Dancer Signature: Date: Parent / Guardian Signature (if under 18): Date: 10
ROOMMATE REQUEST FORM AGE 17 & UNDER ONLY Dancers housed at Belmont University will stay in Horrell Hall, one of Belmont's newest residential complexes opened in January 2013. Horrell Hall features four and five bedroom apartments with a kitchen area and one bathroom per apartment. All roommate requests must be received by March 31, 2017 and all requests must be mutual, meaning both parties involved must request each other. Roommates must also enroll in the same session to be placed together. Remember, housing availability is not guaranteed after March 31, 2017. Because accommodations are apartment style, you may request up to 4 (four) other dancers as roommates. Nashville Ballet will make every effort to accommodate your request, but cannot guarantee whether dancers will be assigned to a four or five bedroom apartment. Dancers age 18 and over will be assigned roommates at random. Roommate requests are not available. PLEASE PRINT CLEARLY AND USE FULL FIRST AND LAST NAMES I request the following individuals as my roommate(s): 1. 2. 3. 4. Prior to the start of your session, you will receive an email from our Summer Intensive staff with your roommate assignments. We encourage you to contact your roommates ahead of time to get acquainted! 11
OFF CAMPUS HOUSING WAIVER If you will stay in off campus housing during Summer Intensive, you are required to sign this form. Housing Arrangements / Leases: Nashville Ballet is not responsible or liable for the consequences of any off-campus dancer housing arrangement. Nashville Ballet will not be involved in any negotiations between you (the leaseholder) and any landlord, property owner, dancer, prospective dancer or realtor before, during or after any agreement. In addition, Nashville Ballet does not endorse or sponsor any agencies, services, advertisements, properties, or landlords. Off Campus Safety: Neither Nashville Ballet nor their respective employees, representatives, officers, advisors, subcontractors or agents serve, in any capacity, as agents for the owners of off campus housing. Furthermore, neither Nashville Ballet nor their respective employees, representatives, officers, advisors, subcontractors or agents own, officially recognize, possess any knowledge of nor make any guarantees or warranties about the physical, electrical, plumbing or structural condition of the listed properties or whether the properties comply with municipal, state or other governmental, structural, fire or safety codes or regulations. Therefore, Nashville Ballet and their respective employees, representatives, officers, advisors, subcontractors or agents shall be released and held harmless from any and all liability, actions, causes of action, claims and demands of any kind and nature which may arise out of or in connection with the listing, renting, damage, use or occupation of these properties. Anyone renting off campus housing assumes the responsibility to investigate the physical or structural condition of the properties and their compliance with fire and safety codes or regulations, and are strongly encouraged to do so. Overall Injury / Damages: In no event shall Nashville Ballet be responsible for or liable for any injury or damages of any kind related to the use or misuse of information provided herein and/or for the consequences of any off-campus dancer housing arrangement. By providing this information, Nashville Ballet neither stands in loco parentis to its dancers nor assumes a duty to care for its dancers with respect to any off-campus housing arrangement. Age Recommendations and/or Restrictions: Nashville Ballet strongly advises that only dancers over age 18 pursue off campus housing. Any dancer under age 18 living in off campus housing must have the signature of a parent and/or guardian AND proper notarization on this document. Transportation: Any dancer living in off campus housing is responsible for his/her own transportation at all times. Using his/her own transportation, the dancer is expected to arrive promptly each day for Nashville Ballet s scheduled classes and/or activities. Behavior: While living in off campus housing, dancers attending Nashville Ballet s Summer Intensive are expected to conduct themselves appropriately. Disorderly conduct, arrest, etc. are grounds for dismissal from the Summer Intensive. Any dancer dismissed from the Summer Intensive will not be refunded or reimbursed for any travel expenses. There will be no tuition refunds of any kind. Dancer Signature: Date: Parent / Guardian Signature (if under 18) : Date: ----------------------------------------------------------------------------------------------------------------------------- -------------------------------------Notarization (if under 18): 12
CATERED LUNCH ORDER FORM FOR DANCERS WHO ARE NOT PAYING FOR MEALS (TUITION ONLY) Email: Phone: I would like to order lunch Monday through Saturday for the duration of my session. Session A five days x $10 per day $50.00 (M-F only) Session B 11 days x $10 per day $110.00 Session C 11 days x $10 per day $110.00 Session D 17 days x $10 per day $170.00 Session E 29 days x $10 per day $290.00 Pre-Professional 29 days x $10 per day $290.00 Single day lunch purchase is not available. Lunch will be delivered to Nashville Ballet from a variety of local restaurants. Dietary Needs: Gluten free Vegetarian Nut allergy Other: Payment in full is required by April 1, 2016. Orders may not be changed, modified or cancelled at any time. Refunds will only be given if the dancer does not attend the entire Summer Intensive due to illness or injury. MasterCard Visa Amex Discover Money Order # Check # Credit Card # Exp. Date: Security Code: Billing Zip Code: Name on Card: Authorizing Signature: I hereby authorize Nashville Ballet to charge the above named card for Summer Intensive 2016 lunches as indicated above. I understand that the deposit will be charged immediately upon receipt. 13