The Northwest Arkansas Conservatory of Classical Ballet RETURNING STUDENT REGISTRATION FORM (One form for each student)

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1 The Northwest Arkansas Conservatory of Classical Ballet RETURNING STUDENT REGISTRATION FORM (One form for each student) Today s Date: *PLEASE PRINT CLEARLY* Student s Name: Trainee or Jr. Trainee Program Member? Y N School/DayCare/Homeschool: Grade Level: Has student suffered any injuries or illnesses this past year that would restrict training? If so, what? Have phone numbers or s changed since last year s registration? Y N If so, please update on back of this form. Is the student on medication? Y N If yes, please list: Has student taken RAD classes? Grade or Level Instructor: Last Exam Tested: Test Results: Will any siblings be enrolling at The Conservatory? If so, please list: WAIVER/LIABILITY FORM: I understand that the instruction offered by The Northwest Arkansas Conservatory of Classical Ballet in which the abovenamed student(s) is participating, involves risks of accident and/or injury. Understanding those risks, I personally, as parent or legal guardian or adult age self of the above mentioned student(s), intending to be legally bound, do hereby, for myself, my heirs, executors, and administrators, waive and release The Northwest Arkansas Conservatory of Classical Ballet, all officers, representatives, successors, employees, contractors, and assigns, from any and all liability and damages for any injury, illness, or death that may be sustained by the student(s) in connection with his/her traveling to or participating in and returning from any activity or program associated with The Northwest Arkansas Conservatory of Classical Ballet, whether caused by The Northwest Arkansas Conservatory of Classical Ballet negligence, the actions of the student, or otherwise. I also understand that any other children I bring as guests are included in this waiver form. Further, I grant The Northwest Arkansas Conservatory of Classical Ballet and all employees and/or directors and faculty permission to authorize any emergency medical treatment that may be required for the student for injuries sustained during the student s (s ) participation in the Conservatory instruction and/or performances, activities. It is understood that The Northwest Arkansas Conservatory of Classical Ballet will make an effort to contact me prior to the emergency treatment of the student(s) listed above, but that treatment by a licensed physician or medical staff person of a licensed emergency room will not be withheld if I cannot be reached. In Case of Emergency, please notify: Phone: OR Phone: I, the undersigned, have read this release/authorization and understand all of its terms. I execute it voluntarily and with full knowledge of its significance. I also wish to continue my previous Photo/Video/Audio/Communication Release for the 2015/2016 year. Parent/Legal Guardian/Adult Self Signature Date

2 NORTHWEST ARKANSAS CONSERVATORY OF CLASSICAL BALLET DRAFT AUTHORIZATION Must attach VOIDED check. Name on account: I(we) hereby authorize The Northwest Arkansas Conservatory of Classical Ballet (Company) to initiate debit entries in the amount of and to initiate, if necessary, credit entries and adjustments for any debit entries in error to my (our): (choose one of the following) Checking Account Savings Account Depository Name (Bank): City and State: Transit/ABA#(Router#) Account #: This authority is to be effective beginning and will remain in effect through. The company has received written notification from me, (Signature here) and of its termination in such time as to afford the company and depository a reasonable opportunity to act on it. Tuition will be drafted on the 5 th of each month, or on the next business day. I understand that these are non-refundable installment payments for the 9 month school term. Attach VOIDED check below.

3 NWA CONSERVATORY OF CLASSICAL BALLET TUITION CONTRACT Today s Date: Total 9 month Tuition Fee: Cash/Credit/Check# Name of Student(s): Parent s Name: (please print) Upon enrollment each student is required to complete a registration form with all pertinent information, which is then used to determine applicable tuition. The registration form is our official tuition indicator for each student unless the parent contacts the office directly. Notification of class changes must be received immediately or you will be responsible for tuition amount on our current records. Changes will be confirmed by . If the Installment Plan is used, tuition is due for each student on the 1 st of each month. It is late on the 10 th and a late fee will be charged by the 15 th of the month. Tuition remains the same throughout the nine months regardless of school holidays or vacations. Personal or sick time off from class will not alter your fee. Students wishing to make up missed class time may consult with either the Director or Principal about taking an alternative class. No monetary credit is given for missed classes. Full Tuition for the nine months that are paid in full at the beginning of the contract will be given a 10 % discount. If you are a Peggie Wallis Legacy Student, please notify the Director about the Director about Legacy Donation Fund. This should be done at time of registration. Please check the appropriate space: I will pay each semester in full. First semester due at fall registration. Second semester due January. I will pay the full nine months at the time of registration. CHECK OR CASH OPTION: I will pay in 9 equal installments each month on the 1 st AUTO-DEBIT OPTION: I elect to pay by auto-draft in 9 equal monthly installments. I, the undersigned, understand that it is up to the parent to remember payments. The Conservatory will not issue monthly statements. Any question regarding student/family accounts will be directed to the business manager through the school principal or school director. I also understand the policies and formats The Northwest Arkansas Conservatory of Classical Ballet has set forth and agrees that I am the responsible party to pay the tuition of the above-referenced student(s). Name of Parent or other Responsible Party Date

4 WORKSHEET - *Changes to schedule must be approved and submitted in writing to the office. DATE: STUDENT NAME #1 CLASS DAY/TIME Teacher Discount CLASS TUITION SUBTOTAL STUDENT NAME #2 CLASS DAY/TIME Teacher Discount CLASS TUITION DISCOUNT CODES: AD = Auto Debit (5.00 off monthly installment) MS = Multi-Student (10% off per additional student) SP/FP = Semester or Full Payment (10% off year) L = Legacy (Wallis 2012 student gets 2 nd RAD class at no charge, but must take either graded Mock exam or have Vocational Exam goal. TP = Member of Trainee or Jr. Trainee Program REGISTRATION FEE: Recv d Y N MS discount -10% SUBTOTAL COMBINED TOTAL Discount Code Total after discount TOTAL FOR YEAR MONTHLY or SEMESTER INSTALLMENT Today s Payment Check # Cash Approved by 1 st Sem: 2 nd Sem:

5 WORKSHEET for changes made to original class registration. *DATE: STUDENT NAME New class DAY/TIME Teacher Discount CLASS TUITION SUBTOTAL New Class DAY/TIME Teacher Discount CLASS TUITION DISCOUNT CODES: AD = Auto Debit (5.00 off monthly installment) MS = Multi-Student (10% off per additional student) SP/FP = Semester or Full Payment (10% off year) L = Legacy (Wallis 2012 student gets 2 nd RAD class at no charge, but must take either graded Mock exam or have Vocational Exam goal. TP = Jr. Trainee or Trainee Program member MS discount -10% SUBTOTAL COMBINED TOTAL Discount Code Total after discount TOTAL FOR YEAR MONTHLY or SEMESTER INSTALLMENT Today s Payment Check # Cash Approved by

6 The Northwest Arkansas Conservatory of Classical Ballet REGISTRATION FORM for NEW STUDENTS (One form for each student) Is student a member of the Today s Date: Trainee or Jr. Trainee Program? Yes No How did you hear about us? *PLEASE PRINT CLEARLY* Student Name (Last) (First) (Middle) Date of Birth: Age: Gender: Male Female (circle) School/DayCare/Homeschool: Grade Level: Parent/Guardian: Relationship to Student: Full Mailing Address: Street Address City/State/Zip Parent Cell Phone: Home Phone: Parent s Place of Employment: Work Phone: Student s Cell Phone: Student Work Phone: PARENT ADDRESS: STUDENT ADDRESS: Allergies: Past or Present Injuries: Medical Restrictions: Is the student on medication? Y N If yes, please list: How many years en pointe? Years of dance training? Style: PAST TRAINING FACILITIES AND EXPERIENCE: Please finish on back if more room is needed. Previous ROYAL ACADEMY OF DANCE training? Yes No Instructor: Last Exam Tested: Test Results: Date of last exam: Will any siblings be enrolling at The Conservatory? If so, please list:

7 WAIVER/LIABILITY FORM: I understand that the instruction offered by The Northwest Arkansas Conservatory of Classical Ballet in which the abovenamed student(s) is participating, involves risks of accident and/or injury. Understanding those risks, I personally, as parent or legal guardian or adult age self of the above mentioned student(s), intending to be legally bound, do hereby, for myself, my heirs, executors, and administrators, waive and release The Northwest Arkansas Conservatory of Classical Ballet, all officers, representatives, successors, employees, contractors, and assigns, from any and all liability and damages for any injury, illness, or death that may be sustained by the student(s) in connection with his/her traveling to or participating in and returning from any activity or program associated with The Northwest Arkansas Conservatory of Classical Ballet, whether caused by The Northwest Arkansas Conservatory of Classical Ballet negligence, the actions of the student, or otherwise. I also understand that any other children I bring as guests are included in this waiver form. Further, I grant The Northwest Arkansas Conservatory of Classical Ballet and all employees and/or directors and faculty permission to authorize any emergency medical treatment that may be required for the student for injuries sustained during the student s (s ) participation in the Conservatory instruction and/or performances, activities. It is understood that The Northwest Arkansas Conservatory of Classical Ballet will make an effort to contact me prior to the emergency treatment of the student(s) listed above, but that treatment by a licensed physician or medical staff person of a licensed emergency room will not be withheld if I cannot be reached. In Case of Emergency, please notify: Phone: OR Phone: I, the undersigned, have read this release/authorization and understand all of its terms. I execute it voluntarily and with full knowledge of its significance. Parent/Legal Guardian/Adult Self Signature Date PHOTOGRAPHIC/VIDEO/AUDIO/COMMUNICATION RELEASE: I authorize The Northwest Arkansas Conservatory of Classical Ballet to take and use any photographs, video or sound recordings of me/my child and any other reproductions or adaptations of me/my child s likeness ( the material ), either in full or part, in conjunction with any wording or drawings, in a NWA Conservatory of Classical Ballet class, production, or presentation. I acknowledge that I have/my child has no financial/legal or royalties right in the material used for whatever purpose, nor in The NWA Conservatory of Classical Ballet class, production, presentation or any publications that includes the material. All photographs, choreography, costuming, video or sound recordings, scripts are subject to copyright laws. Any unauthorized reproduction of any kind, other than for The NWA Conservatory of Classical Ballet uses, will be subject to legal action. Likeness permitted? Yes No Child s name permitted? Yes No Agreement signature: Date:

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