BYB-Summer Enrollment

ENROLLMENT FORM

SUMMER ENROLLMENT FORM

SUMMER 2009 ENROLLMENT FORM

Please complete the following form and simply click the "Submit" button once. Administrative staff will contact you shortly.

Or, you can download the following Enrollment Form in PDF format or Enrollment Form in Word format, fill in the information and send it back to us. Our address is 1595 Mercer Rd., Suite 150, Lexington, KY 40511.

If you have any questions about enrolling in BYB, please call 859-271-4472. Our staff can assist you. Thank you.

* indicated required field, which information must be provided in order to submit the enrollment form successfully. If any of the required field is not applicable, please enter n/a and proceed to the next question.

I would like to enroll for: *
Summer Session of Classes June 15-July 25
Please specify which class (day and time)

Summer Intensive Workshop (June 15-July 3) (Evaluation required prior to enrolling)
June 15-19 June 22-26 June 29-July 3

Young Dancer Workshop (July 20-31)

Kids Fun Arts Workshop
July 6-10 July 13-17

1. Student's Name: *

2. Age: 3. Date of Birth: 4. School Grade:

5. Home Address: *

6. City: * 7. State: * 8. Zip Code: *

9. School Attending:

10. Home Phone: * 11. Cell Phone: *

12. Parent's or Student's Email: *
(Your Email address will be used for BYB communicative purpose only.
Please submit your current Email address.)

13. Mother's Name:

14. Father's Name:

15. Emergency Contact Number:

16. Training:
*

17. Medical Conditions:
*

18. How did you hear about BYB?:
*

Waiver of Liability:
I, the undersigned unconditionally release and discharge Bluegrass Youth Ballet, inc. and its faculty and staff, employees, directors and volunteers from any and all liability arising from, related to, or connected with any injury, illness or damage caused by, resulting from, or sustained in the course of my participation in classes, performances or other activities conducted by or associated with Bluegrass Youth Ballet, inc. I hereby attest that this Waiver of Liability is provided voluntarily and shall by fully binding upon my heirs, next-of-kin, executor, administrator and/or personal representative.*

I HAVE READ AND UNDERSTOOD THE BLUEGRASS YOUTH BALLET RULES AND POLICIES

Student attending BYB Summer Intensive for first time must attach a small resume, a letter of recommendation and a photo in first arabesque with this application.