Chicago Ballet Arts Summer Class Registration: 2024
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STUDENT INFORMATION
Student's Last Name: *
Student's First Name: *
Date of Birth: *
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This student is registering for the following:
Session I: 7/8 - 7/20
Session II: 7/22 - 8/3
Mini Movers
Creative Movement
Ballet Beginnings
Primary Ballet
Ballet A
Ballet B
Ballet C
Ballet D
Ballet D w/ pointe
Youth Modern
Teen Modern
Name of primary dance school for 2023-24: *
If applicable. If student has not danced previously, please write "n/a."
Please list any specific student information like allergies, injuries, pronouns, or other details that you'd like CBA to be aware of:
PARENT/GUARDIAN INFORMATION
Parent/Guardian's Full Name: *
Primary Contact Email: *
Primary Contact Phone Number: *
Additional Parent/Guardian's Full Name
Additional Contact Email:
Additional Contact Phone Number:
Street Address: *
City and State: *
Zip Code: *
EMERGENCY CONTACT INFORMATION
In the event of an emergency, the parent/guardian(s) listed above will be contacted first. If we are not able to reach a parent/guardian, we will contact the emergency contact listed below.
Emergency Contact's Full Name: *
Emergency Contact's Phone Number: *
LIABILITY & MEDIA WAIVER
I hereby release Chicago Ballet Arts, its agents and employees, from all liability for personal injury, illness, or property loss or damage. I give consent for staff and personnel to take and use photographs and/or video of my student for CBA's promotional purposes, including for use on its website, social media, posters and other materials.

By checking this box I have read and agree to the above waiver and understand that this will serve as my electronic signature. *
Required
COVID WAIVER
For the health and safety of our students, staff and visitors, as well as those in the communities we serve, we ask that students follow CDC guidelines in the event of a positive COVID test or known exposure. CBA reserves the right to adjust its COVID policy if needed due to health or safety concerns.
By checking this box I have read and agree to the above COVID-19 waiver and understand that this will serve as my electronic signature. *
Required
OPTIONAL INFORMATION
Please include any additional information you'd like CBA to be aware of regarding this registration.
How did you hear about our summer classes?
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