Urbino Registration Form

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)
SML

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

URBINO: July 19 to July 23, 2021

Choose the option for the weeks you will be attending (required)
1 week Intensive with housing $1,550 USD

Dates Attending (required)

Do you need housing? (required)?
YesNo

Do you need Meal Plan? (required)?
YesNo

Payment

Please Indicate Method of Payment
Cashier CheckWire Transfer

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)

ID# (required)

Plan Type (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 June 1, 2021. 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

Important!

You must agree to the Waiver and Release Agreement (Click to Read)

Accept

Balance Due Dates

Tuition Balance Due in Full: February 10th, 2021