Academy Registration

Please fill out the form below to register, or click here to download the registration form. You may send your completed form to [email protected] or print it and return it to the studio.

Student Information

Name of Student

Audition #

Date of birth

Gender

Age

Grade

Home address

City

State

Zip code

Home telephone

Academic school

How did you hear about us?

Please list previous training, including schools and teachers.

Parent/Guardian One

Name of parent/guardian

Home address (if different from student)

City

State

Zip code

Home phone (if different from student)

Cell phone

Parent/guardian two

Name of parent/guardian

Home address (if different from student)

City

State

Zip code

Home phone (if different from student)

Cell phone

Waiver of Liability/Medical/Media Release/Agreement to Pay

I am aware that dance training places unusual stress on the body. On behalf of my child and myself, I assume the risk and agree that the International Ballet Academy of Norwell, IBA Norwell Student Company, Board of Directors, Faculty and any of the chaperones and agents shall not be liable in any way for any injuries sustained or loss of property during attendance at the academy or any of its related functions. My child has permission to be treated for emergency medical care.

Waiver agreement

I agree

Medical insurance and number

Please share any information that will help us provide a safe and positive experience for your child while at IBA Norwell such as allergies, sepecial medical conditions or learning disabilities.

I give my permission for photographs or television footage that include my child to be used for promotional purposes on television, newspapers, magazines, brochures, billboards or any other form of advertising.

I understand that IBA Norwell can cancel classes that have less than 12 students enrolled and reserves the right to change teachers and staff. I understand and agree that there are no refunds for any reason. A nonrefundable $25 registration fee and tuition deposit is due upon submission of this form. A 4-month payment plan is available with an additional $30 fee and payments are due by the 1st of each month. Full payment is due by December 1 of the current calendar year.

There will be a $25 service charge for all checks received with insufficient funds.

No refunds for any reason. In the case that we are required to close the Academy due to Corona Virus, classes will resume on ZOOM.

Please indicate how you will be paying tuition.

Full payment Installment payment

Electronic signature

Date