2024 Summer Ballet Intensive and 2nd Semester Audition Registration Form

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Email *

Are you a current student at The Portland Ballet? *

Yes, I am currently enrolled or have previously been enrolled at The Portland Ballet

No, I am a new student to The Portland Ballet

I am attending TPB's audition on Monday, January 15, 2024 *

Yes

No, but I have emailed academy@theportlandballet.org (current students) or admissions@theportlandballet.org (new students) and have made alternative audition arrangements

Required

Program Auditioning for *

Summer Ballet Intensive 2024 (July 1 - August 3, 2024, Ages 11-18

2nd Semester Career Track (February - June 2024, Ages 14 - 22)

2nd Semester Curriculum Ballet (February - June 2024, Ages 6 - 18)

Required

Performance Opportunities

Please select all you'd like to be considered for

(Career Track and Curriculum ONLY)

Spring Production ( A Midsummer Night's Dream) Levels 3+

Youth Company ages 14+

Dancer First Name *

Dancer Last Name *

Dancer Birthdate *

YYYY

Academic School and Grade for 2023-24 School Year *

Home Address:

Street Address

Home Address:

City

Home Address

State

Home Address:

Zipcode

Dancer Cell Phone *

Dancer Email *

Dancer Gender Identity and Pronouns

Other Extracurricular Activities

Guardian #1 Name *

Guardian #1 Place of Work *

Guardian #1 Phone Number *

Guardian #1 Email Address *

Guardian #2 Name

Guardian #2 Place of Work

Guardian #2 Phone Number

Guardian #2 Email Address

Primary Billing Contact *

Guardian #1

Guardian #2

Current Training: Studios/Workshops (when/number of years) *

Previous Training: Studios/Workshops (when/number of years) *

Number of Years En Pointe (if applicable)

Will you participate in any other dance programs outside of TPB for the 2023-24 academic year? (Including school dance programs) *

Yes

N/A - auditioning for Summer Ballet Intensive

If you answered "Yes" to the previous question, please list the other program(s)

Please list previous summer intensives, including: year attended, key teachers, and any scholarship received *

Please list performance experience *

Will you be applying for financial aid?

$55 Application fee is due at the time of application to the financial aid assessment service, not on receipt of this form. If the application fee is a barrier, please email academy@theportlandballet.org for more information.

Yes

Please list pertinent medical information (allergies, medication, etc.) *

Do you currently have health insurance? *

Yes

How did you hear about TPB? *

As an organization funded by the Regional Arts and Culture Council, we are partnering with RACC and the City of Portland on a diversity initiative. We are asking for your support in moving this initiative forward. Please answer the following questions:

African American or Black

Asian

White/Caucasian/European

Latinx/Latina/Latino

Multi-racial

Native American or Alaska Native

Native Hawaiian or Pacific Islander

I respectfully decline to answer

Other:

What is your preferred language?

RELEASE OF LIABILITY

I acknowledge that dance instruction is strenuous physical activity involving the risk of physical injury and have taken all steps necessary to learn of any physical impairment(s) that would limit or affect my safe participation. I voluntarily assume all risks arising from my participation in dance instruction and hereby release and waive all claims against The Portland Ballet (TPB), any instructor contracted by TPB to provide dance instruction, and any and all of the other participants in class for any damages arising out of my instruction, demonstrations, or performances. I further agree to hold harmless and indemnify The Portland Ballet, any instructor contracted by TPB to provide dance instruction, and any and all of the other participants in class from any loss, cost, or expense, damage or injury arising from my participation in dance instruction, demonstration, or performances.

By checking this box I agree to the above Release of Liability

Required

PUBLICITY RELEASE AND HOLD HARMLESS

I hereby authorize and give full consent to The Portland Ballet to write, publish, and prepare articles, photographs, videotapes, or DVDs concerning my activities in connection with TPB. TPB may use, or cause to be used, these articles, photographs, videos or DVS for any and all exhibitions, public displays, including website, email and social media platforms, commercial art for advertising purposes, without limitation, reservation or compensation.

I specifically waive and relinquish any and all rights to videotaping and sound recordings of my activities described above with full knowledge videotaping may subsequently be distributed for showing to the public, and I further waive and relinquish any and all rights with respect to such distribution and showing.

I agree to hold TPB and its agents free and harmless from all liabilities resulting from their active or passive negligence, but not from willful negligence, causing injury to me or to my property.

By checking this box I agree to the above Publicity Release and Hold Harmless statements

Required

Release of Liability: Acknowledgment of Risk

I hereby acknowledge and agree that participation in TPB activities comes with inherent risks. I understand the inherent risks associated with participation in TPB activities, including but not limited to slips, trips, and falls, athletic injuries, and illness, including exposure to and infection with viruses or bacteria. I further acknowledge that the preceding list is not inclusive of all possible risks associated with TPB program participation.

By checking this box I agree to the above Release of Liability

Required

Send me a copy of my responses.

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