MASTERCLASS REGISTRATION FORM – QUINTE BALLET SCHOOL OF CANADA

Student Information

First Name *

Last Name *

Gender

Female

Male

Date of Birth *

Current Academic Grade *

Students Cell Phone Number

Students Email Address

Student Contact Information

Father/Guardian's Name (-18)

Mother/Guardian's Name (-18)

Street Address

City

Province/State

Country

Postal Code/ZIP

Email Address *

Home Phone Number

Cell Phone Number *

Fee Information

Fees:
For 2021, Masterclasses are being offered FREE of charge.

Masterclass Location *

(City & Date of Masterclass)

Masterclass Waiver and Consent Form

Each year the Quinte Ballet School of Canada conducts an audition tour for those students seeking acceptance into the Summer Dance Intensive. While precautions are taken to ensure a safe environment, accidents may happen. These accidents result from the nature of the classes and can occur without any fault on either the part of the students, the Quinte Ballet School of Canada, its employees or agents, or the facility where the classes are taking place.

THE CHANCE OF AN ACCIDENT OCCURRING CAN BE REDUCED BY CAREFULLY FOLLOWING INSTRUCTIONS AT ALL TIMES.

The Quinte Ballet School of Canada does not provide any accidental death, disability, dismemberment or medical expenses insurance on behalf of the students participating in the classes and assumes no responsibility for any accident or injury that might be suffered by a student.

ACKNOWLEDGMENT

We have read the above. We understand that by participating in the Quinte Ballet School of Canada master classes and/or audition classes we are assuming the risks associated with doing so.

Liability release *

By checking this box I release QBSC from liability in the event of an accident during the audition and/or master class

Image Consent

I give my consent to QBSC to display or permit publication of photographs or electronic images of this student for use in advertising and media purposes. This may include but is not limited to the QBSC's website and social media sites.