Dancer Name *

First Name

Last Name

Class Choice *

Please choose which class you are registering for

Monday, July 29: INTERMEDIATE

Tuesday, July 30: ADVANCED

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

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Assumption of Risk *

I do hereby assume full responsibility for any and all damages, injuries, or losses that I/we may sustain or incur, if any, while attending or participating in any Myers program and/or during any visit to Myers Ballet School. I/we hereby waive all claims against the Myers Ballet School, its instructors, agents, staff or partners of said studio, individually, or otherwise, for any and all claims for injuries or damages that I/we might sustain. I understand that there is a risk of injury associated with participation in any Myers Ballet School program and I/we certify that I/we are in good physical condition and have no disabilities or other ailments that may hamper my/our participation. I certify that all of the information provided on this document is correct and true.

I have read and agree to the above. This shall act as my electronic signature for myself or my child.

Media Release *

I hereby grant to Myers Ballet School, and their respective licensees, successors and assigns, the right and permission, with respect to photographs and videos taken of me or the minor named below on whose behalf I am signing, and with respect to any printed matter in connection therewith, to do the following: 1. To include such photographs and videos in all media, and in advertising, publicity and promotion thereof. 2. To use my name or the name of the minor on whose behalf I am signing, in connection with the foregoing. I hereby release, discharge and agree to indemnify and hold harmless Myers Ballet School and their respective heirs, legal representatives, licensees, successor and assigns, from all claims and demands whatsoever arising out of or in connection with the foregoing, and waive any right to inspect or approve the same.

I have read and agree to the above. This shall act as my electronic signature for myself or my child.

Statement of Commitment *

I understand that all students who are registered at Myers Ballet School are considered to be serious students who are dedicated to the best training possible. I understand that lack of appropriate behavior and attitude is grounds for immediate dismissal from classes and/or the school. Training will be under the watchful of eyes of Miss Myers and her Professional staff. I understand that any additional training elsewhere will be cause for immediate dismissal from the school.

I have read and agree to the above. This shall act as my electronic signature for myself or my child.

Tuition Agreement *

I agree to pay the appropriate tuition before the start of classes. I understand failure to submit payment will result in the loss of my reserved spot in class(es) and I will not be permitted to participate. I also acknowledge and understand that no refunds, exchanges, credits, or scholarships will be granted for summer classes and I am responsible for paying all of the owed tuition.

I have read and agree to the above. This shall act as my electronic signature for myself or my child.

Class Offerings *

Please indicate the weeks of intensive program you are registering for.

Thursday Beginning Ballet (4:30 - 5:30 pm)

Wednesday Intermediate Ballet (4:00 - 5:30 pm)

Friday Intermediate Ballet (5:30 - 7:00 pm)

Tuesday Advanced Ballet (5:30 - 7:00 pm)

Wednesday Advanced Ballet (5:30 - 7:00 pm)

Thursday Advanced Ballet (6:00 - 7:30 pm)

Monday Adult Ballet (6:00 - 7:30 pm)

Thursday Int/Adv Modern (5:30 - 6:30 pm)