Encinitas Ballet Academy Summer Intensive 2016

Registration and Enrollment

July 11 – July 15, July 18 – July 22, July 25-July 29, and Aug.1- Aug.5.

There are two pages for this application. The first page asks for registration information, and the second page asks for your specific program enrollment preferences.

Please complete and return both pages with applicable fees to Encinitas Ballet.

Name of student: ______

Name of parents (for applicants under 18): ______

Street Address: ______

City: ______State: ______ZIP: ______

E-mail address: ______

Home phone: ______Cell Phone: ______

Emergency contact: ______Phone: ______

Date of birth: ______Age: ______Yrs. Of ballet training: ______

Company or School Affiliation/Dance Teacher(s): ______

Please complete the enrollment form for this application.

Mail or drop off your completed forms and all applicable fees and deposits to: Encinitas Ballet, 264 N. El Camino Real #D, Encinitas, CA 92024

If you have any questions, please contact us at: (760) 632-49-47or www.encinitasballet.com

The Encinitas Ballet Academy nor its principals, agents nor employees shall be liable for any injuries to the person whomsoever, occasioned by directly or indirectly, arising out of any act or omission or alleged act or omission of the Encinitas Ballet Academy or its principals, agents or employees in conjunction with the said lessons being so provided, and further hereby waives all rights to bring an action at law or in equity to recover damages to person or property arising out of or in any manner connected with said lessons. Thank you for your interest in Encinitas Ballet.

Signature ______Date ______Encinitas Ballet Academy Summer Intensive 2016

Enrollment Form

Name ______Please indicate your level:______

Please circle the weeks you are taking and indicate your tuition based on the table below.

Pre- Ballet 1, 2 July 11 – July 15 9AM-12PM $230(1 week)

Level 1, 2 July 25-July 29 2:30PM-6PM $240( 1 week) $450 (2 weeks)

Level 1, 2 Aug.1-Aug.5 9AM-1PM

Level 3 and up July 18 – July 22 9AM-2PM

Level 3 and up July 25-July 29 9AM-2PM

Level 3 and up Aug.1- Aug.5 2PM-7PM

$310 (1 week) $500( 2 weeks) $700(3 weeks)

Tuition due: $______# of weeks ______

Payment Information:

Spaces are limited. Please enclose a $200 deposit (Due June 11st, 2016) to reserve your place.

All tuition is due June 30, 2016.

There are no refunds or credits for missed classes.

Please make check to Encinitas Ballet.

Tuition due $ ______$200 Non-refundable deposit

Required uniform (Encinitas Ballet logo leotard and hair piece) $ ______extra charge

Additional leotards $ ______extra charge Encinitas Ballet T-Shirts $______extra charge

Remaining Balance due $ ______