North Pointe Ballet · 2023 Summer Youth Training INTERMEDIATE Registration

Contact Information

Dancer Name

*

First Name

Last Name

Dancer Age

*

Dancer Gender

Male

Female

Non-Binary

Unknown

Other

Decline to state

Dancer Race

Asian/Asian Americans/Pacific Islander

Black/African American/African

Hispanic/Latino/Latina/Latinx

Native American/American Indian/Indigenous

White/Caucasian/European

Multi-Racial or Multi-Ethnic (2 or more races or ethnicities)

Unknown

Decline to state

Other

Does the dancer have any disabilities, allergies, or other necessary accommodations?

Dancer's Regular Dance Studio

*

Dancer's Regular Dance Teacher

*

Parent Name

*

First Name

Last Name

Parent Email

*

Verify Email

*

Parent Phone Number

*

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Registering For

*

6/19 - 7/21 only

8/2 & 8/9 only

All 7 weeks

Payment

$180 - 6/21 - 7/19 only

$72 - 8/2 & 8/9 only

$252 - all 7 weeks

I do not wish to pay online but will pay by cash or check by the following date:

(mm/dd/yyyy)

I, the purchaser, agree:

*

TO ASSUME ALL RISK AND DANGER INCIDENTAL TO EVENT, CLASS OR TRAINING WHETHER OCCURRING PRIOR TO, DURING, OR AFTER SAID EVENT.

TO ASSUME ALL RISK AND DANGER OF INJURY AND ILLNESS AND AGREE THAT THE MANAGEMENT -- North Pointe Ballet, and associated parties for those organizations--ARE NOT RESPONSIBLE OR LIABLE FOR ANY INJURIES OR ILLNESS RESULTING FROM SUCH CAUSES.

THAT NORTH POINTE BALLET HAS TAKEN REASONABLE MEASURES TO ENSURE MY SAFETY.

THAT MY NAME, LIKENESS, IMAGE, APPEARANCE, AND/OR PERFORMANCE MAY BE RECORDED IN PHOTOGRAPHIC, AUDIO, OR VIDEO AS A RESULT OF REHEARSING AND PERFORMING WITH NORTH POINTE BALLET (NPB). I GRANT NPB AND ITS AFFILIATES THE RIGHT TO USE THOSE RECORDING IN ANY FORMAT, NOW OR LATER DEVELOPED.