Register for the Student Youth Summer Program

Tuition and registration fees are non-refundable.
Fields with a red * are required.
Price increases after March 30th

Student Information

Student Name*

First Last

Student Email

Age*

Birthdate*

Gender*

M

F

Special Circumstances and Dance Experience

Any medical or allergies, learning, or other special circumstances ARC should be aware of? What is your Dance Experience? If so, please explain:

Guardian Information

Guardian Name*

First Last

Billing Address*

Street Address City State 5 Digit Zip Code

Phone*

Email*

Enter Email Confirm Email

Emergency Contact

Please provide an additional name and phone number to contact in case of an emergency.

Emergency Contact Name*

First Last

Emergency Contact Phone*

Student & Youth Summer Programs

3 Week Program*

June 9 - June 27 There are no make-up classes

Health and Safety Policy

Masks are currently optional. Please stay at home if you have any COVID-19 symptoms.

Agreement*

I agree to follow and abide by all of ARC's health and safety policies. I acknowledge that these may change at anytime.

Is Student fully vaccinated and boosted against COVID-19?*

Yes

No

Payment

Registration Fee*

Price: $25.00

Total

Please review your registration information. Click "Previous" to make any necessary edits, or "Next" to proceed to policy agreement and payment.

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Warranty & Release

If you are under 18 years of age, your parent’s or legal guardian’s signature is required.

By signing below, I agree to the following waiver and release. I acknowledge that I am physically fit and have no health, medical or physical problems that preclude my participation in the activities of ARC Dance Productions (ARC) and Arc School of Ballet (ASB). I understand and acknowledge these activities may require special conditioning and skills and involve risks that may include serious bodily injury, permanent disability, death, and personal property damage, social or economic loss. I understand these risks may arise from any event(s), whether in or out of my control, and these risks may be unforeseeable or unknown to me at this time. I agree that it is my responsibility to examine and inspect each activity I take part in and it is my responsibility to take action to protect myself from risk if I believe risk is inherent in the activity. I fully accept and assume all such risks and all responsibilities for losses, costs and damages I may incur as a result of my participation in these activities and agree that ARC and ASB is in no way liable for any risks incurred from my participation in these activities.

I hold harmless ARC and ASB, its officers, employees and agents from any and all liability, actions, and cause of action, claims and demands of any and every kind that may arise from or in connection with my participation in these activities. ARC and ASB have the absolute and irrevocable right and permission, to use, re-use, publish, and republish the same in whole or in part, individually or in conjunction with other photographs, in any medium and for any purpose whatsoever, including but not limited to, illustration, promotion, advertising and trade, any photos of myself or use of my name, in conjunction with ARC or ASB.

My signature serves as a release and assumption of risk for myself and any members of my family who have accompanied me to these activities, including those under the age of 18 for whom I am a parent or legal guardian. My signature shall bind my heirs and estate to this release and assumption of risk.

By signing below, I, the minor’s parent and/or legal guardian agree that I understand the nature of ARC Dance Productions’ (ARC) and Arc School of Ballets’ (ASB) activities and the minor’s experience and capabilities and I believe the minor to be qualified to participate in such activities. I have read, understand and comply with the agreement signed by the minor and permit the minor to participate in the activities. I hold harmless ARC and ASB, its officers, employees and agents from any and all liability, actions, and cause of action, claims and demands of any and every kind that may arise from or in connection with the minor’s participation in these activities.

MEDICAL AUTHORIZATION

In the event of an emergency or non-emergency situation requiring medical treatment, I hereby grant permission for any and all medical attention to be administered to myself/child/children in the event of an accidental injury or illness, until such time as my emergency contact can be contacted. This permission includes, but is not limited to, the administration of medical treatments and/or procedures deemed necessary under the recommendation of qualified medical personnel. I understand that ARC Dance Productions (ARC) and Arc School of Ballet (ASB) faculty and staff cannot administer emergency medical treatment, therefore in the case of an emergency, ARC and ASB will call 911. I will assume all responsibility for payment(s) of medical treatment. ARC and ASB will not be responsible for any medical costs.

PAYMENT

Being the cardholder and authorized purchaser, I understand and agree to the Registration and Tuition terms and policy, for which I have read and understand; set forth in the ARC Dance and Arc School of Ballet handbook, and in this agreement.

Have you read, understand, and agree to the attached policy?*

Yes

By entering my name in the box below, I certify that I, {Guardian Name (First):16.3} {Guardian Name (Last):16.6} have read and agree to the above waiver.

Signature for Waiver*

Credit Card

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Online Payments

Phone

This field is for validation purposes and should be left unchanged.