Faubourg School of Ballet 2009 - 2010
Registration Form


 Please check if the BELOW information differs from your previous registration.

Student's Name _____________________________________________________________

Guardian's Name ___________________________________________________________

Address ____________________________________________________________________

City ____________________________State_______ZIp____________________________

Guardian's Name __________________________________________________________

Home Phone (     )_____________________Work Phone (     )_____________________

Cell Phone (     )_____________________Age_______Birthdate_________________

E-Mail Address ______________________________Level Assignment__________

FSB, FBT, and Release:
I agree to hold harmless Faubourg Ballet Theatre (FBT), Faubourg School of Ballet (FSB), Ballet Camp Illinois (BCI), or any affiliates associated with this program, for any damage and/or injury, and/or illness during participation in these programs or any event sponsored by them. I also agree that FBT, FSB, and BCI, or any affiliates associated with these programs, is not responsible if the above student leaves the premises for any reason.

Placement and Alignment Release:
This must be signed in order for the student to attend any class or perform. I understand that correct physical placement and body alignment are necessary in order for all dancer movement to be properly executed. I understand and agree that the instructors will be touching my child within a class setting for correction purposes.

Photographic/Video Release:
From time to time we may use printed photographic and/or video recordings of our students for promotional and/or fund-raising materials. I give Faubourg School of Ballet and Faubourg Theatre my permission for the use of any printed photographic and/or video recordings of the above named student to be used for promotional and/or fund-raising materials. With this release I also understand that we will not receive compensation for the use of said materials.

I hereby acknowledge that I have read and agree with the above information and FSB Policies and Procedures as it pertains to the above named student.

By: _______________________________________________Date:________________________

            Signature of parent of guardian

 

Faubourg School of Ballet, LTD.
2009 - 2010

Level Beg Tech 1 Tech 2 Tech 3 Tech 3A Tech 4 Tech 5
Tuition Per Session $105.00 $190.00 $470.00 $470.00 $780.00 $850.00 $850.00
Unlimited
(Classes in assigned level and below)
N/A N/A N/A $670.00 N/A $900.00 $900.00
**Hourly Rate N/A N/A $12.00 $12.00 $12.00 $12.00 $12.00


  CLASS CLASS CLASS CLASS CLASS TOTAL HOURS
MONDAY            
TUESDAY            
WEDNESDAY            
THURSDAY            
FRIDAY            
SATURDAY            

Total Weekly Hours: __________

Tuition Due: __________

Annual Registration Fee: ____$20.00

Total Due: __________

STUDENT NAME:_______________________________________                   LEVEL: _________