Brisbane Registration Form | Russian Ballet International

This year, Bolshoi Ballet Summer Intensive in Brisbane, Australia is provided to students for ONE WEEK SESSION FROM JANUARY 08-12, 2020

YOUNG DANCER PROGRAM

INTERMEDIATE/ADVANCED PROGRAM

For more info, please email:
bolshoiaustralia@mail.com
russianballetinternational@gmail.com

Registration Fee: $125

Upon Registration Non-Refundable

Before you fill out the form below, you must pay the registration fee.

You may pay the registration fee of $125 by Paypal.

Student

First Name (required) Last Name (required)

Permanent Address (required)

City (required)

State (required)

Zip (required)

Home Phone

Cell Phone (required)

Email (required)

Student’s Sex
MaleFemale

Age on Arrival (required)

DOB (mm/dd/yy) (required)

T-Shirt Size (required)

Parents

Parent's Name(s) (required)

Parent #1 Home Phone (required)

Parent #1 Work Phone (required)

Parent #1 Cell Phone (required)

Parents Email

Person Responsible for Tuition and Fees (required)

Program Attending

Brisbane: January 08 to January 12

YOUNG DANCER PROGRAM,
INTERMEDIATE/ADVANCED PROGRAM
Choose the option for the weeks you will be attending (required)

Payment

Please Indicate Method of Payment
Cashier CheckWire TransferPayPal

Emergency Contact

In case parent cannot be reached.
Name (required)

Relationship to Student

Telephone (required)

Doctor Name (required)

Doctor Telephone (required)

Health Insurance

Carrier (required)

Are there any physical problems or pre-existing conditions that may prohibit or affect training? If yes, please describe briefly.

Are there any emotional problems or allergies that we should be aware of? If yes, please describe briefly.

Students must submit a letter from the doctor, stating that the student is healthy to participate in the program and has no illnesses that can affect the student during the program. The letter should be signed by the doctor and provide doctor’s contact info. We should receive this letter no later than January 1, 2020. If we do not receive this letter, you will not be allowed to participate.

Please read and confirm below

I accept my invitation to participate in the Bolshoi Ballet Academy Summer Intensive Program. My signature below certifies that the information given on this registration form is complete and accurate. I understand that the Bolshoi Ballet Academy is not responsible for injuries that occur on its premises. The Bolshoi Ballet Academy maintains a policy of non-discrimination with regard to ethnic background, religion, race and sexual orientation.
Yes

Bolshoi Ballet Academy