<p> Encinitas Ballet Academy Summer Intensive 2016</p><p>Registration and Enrollment </p><p>July 11 – July 15, July 18 – July 22, July 25-July 29, and Aug.1- Aug.5. </p><p>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.</p><p>Please complete and return both pages with applicable fees to Encinitas Ballet.</p><p>Name of student: ______</p><p>Name of parents (for applicants under 18): ______</p><p>Street Address: ______</p><p>City: ______State: ______ZIP: ______</p><p>E-mail address: ______</p><p>Home phone: ______Cell Phone: ______</p><p>Emergency contact: ______Phone: ______</p><p>Date of birth: ______Age: ______Yrs. Of ballet training: ______</p><p>Company or School Affiliation/Dance Teacher(s): ______</p><p>Please complete the enrollment form for this application. </p><p>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</p><p>If you have any questions, please contact us at: (760) 632-49-47or www.encinitasballet.com</p><p>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. </p><p>Signature ______Date ______Encinitas Ballet Academy Summer Intensive 2016 </p><p>Enrollment Form</p><p>Name ______Please indicate your level:______</p><p>Please circle the weeks you are taking and indicate your tuition based on the table below. </p><p>Pre- Ballet 1, 2 July 11 – July 15 9AM-12PM $230(1 week)</p><p>Level 1, 2 July 25-July 29 2:30PM-6PM $240( 1 week) $450 (2 weeks)</p><p>Level 1, 2 Aug.1-Aug.5 9AM-1PM</p><p>Level 3 and up July 18 – July 22 9AM-2PM </p><p>Level 3 and up July 25-July 29 9AM-2PM</p><p>Level 3 and up Aug.1- Aug.5 2PM-7PM</p><p>$310 (1 week) $500( 2 weeks) $700(3 weeks)</p><p>Tuition due: $______# of weeks ______</p><p>Payment Information:</p><p>Spaces are limited. Please enclose a $200 deposit (Due June 11st, 2016) to reserve your place. </p><p>All tuition is due June 30, 2016. </p><p>There are no refunds or credits for missed classes.</p><p>Please make check to Encinitas Ballet.</p><p>Tuition due $ ______$200 Non-refundable deposit </p><p>Required uniform (Encinitas Ballet logo leotard and hair piece) $ ______extra charge </p><p>Additional leotards $ ______extra charge Encinitas Ballet T-Shirts $______extra charge </p><p>Remaining Balance due $ ______</p>