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Student Registration
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(Please choose the number of non-adult students you will be registering for the BBT year-round program).
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One Student
Two Students
Three Students
Four Students
Five Students
Student First Name
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Student Last Name
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Student Age
Full Program / Drop-In Classes?
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Full Program
Drop-In Classes
Level
Beginner
Intermediate
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Gentlemen
Student 2 First Name
Student 2 Last Name
Student 2 Age
Student 2 Full Program / Drop-In Classes?
Please note: If you are registering your student for drop-in classes, they will not be eligible to participate in any BBT performances.
Please Select…
Full Program
Drop-In Classes
Student 3 First Name
Student 3 Last Name
Student 3 Age
Student 3 Full Program / Drop-In Classes?
Please note: If you are registering your student for drop-in classes, they will not be eligible to participate in any BBT performances.
Please Select…
Full Program
Drop-In Classes
Student 4 First Name
Student 4 Last Name
Student 4 Age
Student 4 Full Program / Drop-In Classes?
Please note: If you are registering your student for drop-in classes, they will not be eligible to participate in any BBT performances.
Please Select…
Full Program
Drop-In Classes
Student 5 First Name
Student 5 Last Name
Student 5 Age
Student 5 Full Program / Drop-In Classes?
Please note: If you are registering your student for drop-in classes, they will not be eligible to participate in any BBT performances.
Please Select…
Full Program
Drop-In Classes
Parent / Guardian 1 First Name
*
required
Parent / Guardian 1 Last Name
*
required
Preferred Mailing Address
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required
City
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required
State
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required
Zip Code
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required
Parent / Guardian 1 Cell Phone Number
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required
Parent / Guardian 1 Email Address
*
required
Parent / Guardian 2 First Name
Parent / Guardian 2 Last Name
Parent / Guardian 2 Cell Phone Number
Parent / Guardian 2 Email Address
Is the student en pointe?*
Yes
No
Please list years en pointe.
Please list the student's prior ballet experience
(New students only)
I am / We are interested in joining the Friends of the Ballet
Yes
No
Photo / Publication Permission
Maine Central Institute requests permission to publish photos / videos of your student and to identify your student by name on the MCI website and social media, in school publications, or in the local media (i.e. newspapers) for the purpose of promoting school news, activities and achievements.
Permission
*
required
Please Select…
Yes
No
Liability Release
Intending to be legally bound hereby, the undersigned agrees and does hereby release from liability and to indemnify and hold harmless Maine Central Institute of Pittsfield, Maine, and any of its employees or agents representing or related to the School. Other than in cases of neglect by the School, this release is for any and all liability for personal injuries (including death) and property losses or damage occasioned by, or in connection with any activity or accommodations for this program. The undersigned further agrees to abide by all the rules and regulations promulgated by Maine Central Institute an/or its affiliate groups and vendors.
The undersigned agrees to the statement of TERMS AND CONDITIONS OF ENROLLMENT in BBT at MCI for the 2020-21 Year-Round Program. This agreement and all the terms and conditions of enrollment become binding upon the last signature date noted below.
Release
*
required
Please Select…
I agree
Electronic Signature
Signature*
By clicking this box, I agree that all the information above is true to the best of my knowledge. I also agree to notify the Business Office immediately if any of the above information changes.
Yes
Full Name
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Date
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(mm/dd/yyyy)
Please send a confirmation email to the address below*: