MASTERCLASS REGISTRATION FORM If you are human, leave this field blank. 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: Masterclass ONLY : $30 Audition ONLY : $50 Masterclass and Audition : $60 Please contact the administrative office at info@quinteballetschool.com or 613-962-9274 ext. 21 to make payment arrangements. 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. How did you hear about this Masterclass? * Website Social Media Magazine Current dance school Word of mouth Returning student Other. Please specify:Other. Please specify: * Parent/Legal Guardian signature is not required for students 18 years of age and older. Section