2023 Summer Registration
Cleveland City Ballet
445 Church Street SE Suite 2201 Cleveland, TN 37311
423-472-0167
dance@clevelandcityballet.com
www.clevelandcityballet.com
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Email *
Dancer Date of Birth *
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DD
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Dancer's LAST Name *
Dancer's FIRST Name *
Mailing Address (Street, City, State, Zip) *
Allergy / Health Concerns *
Parent / Guardian Name *
Parent / Guardian Contact Number (no dashes) *
Emergency Contact Name *
Emergency Contact Number (no dashes) *
School Attending *
School Grade  (as of Fall 2023) *
T-Shirt Size (unisex) *
Disclaimer: Class sizes are limited and placement in the class will not be reserved until formally registered. Your signature are an acceptance of financial responsibility for this commitment and withdrawal is only by written notice. You are responsible for recital and costume fees for participation in the spring recital. If you chose not to participate, written notice must be received by the last class in December. No refunds will be given. *
Release: By enrolling my child, I understand my child’s picture may be taken. I also understand that his/her picture may be used in Cleveland City Ballet publications (brochures, website, etc). No child will be identified by name in any publication. *
Release: As the parent or legal guardian of this child, I give my permission for staff and representative of Cleveland City Ballet to administer necessary first aid, and/or take the child to a medical facility for treatment. I understand every effort will be made to contact me and/or emergency contact listed if any treatment is necessary. I also release and discharge Cleveland City Ballet and their staff and representatives from all liability of any kind from claim, demand or cause of action which might be asserted on behalf of said child as a result of participation in this activity. *
Princess Ballerina Camp (Ages 3-6)
Try-It-All Dance Camp (Ages 6-12)
Dance Intensive (Ages 10+)
A copy of your responses will be emailed to the address you provided.
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