CBA Pre-Professional Intensive Registration: 2023
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STUDENT INFORMATION
Student's Last Name: *
Student's First Name: *
Date of Birth: *
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Name of primary dance school for 2022-23: *
How many years of ballet training has this student had? *
Does this student currently study pointe? *
Required
Has this student studied any other styles of dance? If yes, please list the styles and approximate number of years. If no, please write "n/a." *
Student's Email:
Please list any allergies, injuries or other student information that you'd like CBA to be aware of:
PARENT/GUARDIAN INFORMATION
Parent/Guardian's Full Name: *
Additional Parent/Guardian's Full Name
Parent/Guardian's Primary Contact Email: *
Additional Contact Email:
Primary Contact Phone Number: *
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 will be contacted first. If we are not able to reach them, we will contact the person listed as the emergency contact.
Emergency Contact's Full Name: *
Emergency Contact's Phone Number: *
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, all who may be physically present at Chicago Ballet Arts are asked to confirm:

1. I/we state that I have not tested positive for, am not subject to a quarantine due to the Coronavirus, and am not currently awaiting Coronavirus test results. I have not been diagnosed with COVID-19 within the past 10 days;

2. I/we do not currently have a fever or respiratory illness, including cough, difficulty breathing, or shortness of breath, or other symptoms associated with COVID-19;

3. I/we agree that if any of the above confirmations are untrue at the time of any studio usage, I/we will not enter the studio and will notify Chicago Ballet Arts administration immediately.

4. I/we am proceeding with studio usage at my own risk. Because the studio is open for use by other individuals, I recognize that I are at higher risk of contracting COVID-19. With full awareness and appreciation of the risks involved, I hereby forever release, waive, discharge, and covenant not to sue Chicago Ballet Arts, its board members, officers, agents, servants, independent contractors, affiliates, employees, successors, and assigns (collectively "Released Parties") from any and all liability, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, or injury, including death, that may be sustained by me related to COVID-19 whether caused by the negligence of the Released Parties, any third-party using the studio, or otherwise, while participating in any activity while in, on, or around the studio and/or while using any studio facilities, tools, equipment or materials.

5. I/we understand that CBA may adapt its COVID policies based on guidance from the CDC and/or state or local government and agree to comply with measures that may be put into place for the health and safety of the school.

Parents/Guardians acknowledge that they are signing on behalf of their family, including all children in their care that may enter the building, including for any future visits. Individuals acknowledge that they are signing for themselves for any time they enter the building, including for any future visits.

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
How did you hear about our summer intensive?
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