Lower School Registration If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required. 2018-2019 Academy Year Levels 1 through 4 Student's Full Name * Level Tuition Registration Fee * Registration Fee ($30)Military Discount: FREE Registration* ($0)Family Discount: $50 for all students in familyAdditional Sibling, if taking Family Discount for other sibling ($0)Full Year Tuition Payment Discount ($0) *Military ID required before first class Please select your level/class and payment selection (monthly or full year option). Level 1 Two 1.25 hour ballet technique classes per week » Mon. 5:00 to 6:15 pm and Wed. 5:00 to 6:15 pm $136 per month $1,360 full year tuition Level 2 Two 1.5 hour ballet technique classes per week » Mon. 5:00 to 6:30 pm and Wed. 5:00 to 6:30 pm Modern 1 » Mon. 6:30 to 7:30 pm $196 per month$1,960 full year tuition Optional Electives: Level 1 Select payment type AND day/time Beg Tap ($40 per month)Beg Tap ($400 full year)» Beginning Tap (Sat. 11:00 am - noon) Optional Electives: Level 2 Select payment type AND day/time One Elective ($40 per month)One Elective ($400 full year)» Beginning Tap (Sat. 11:00 - Noon) Level 3 Three 1.5 hour ballet technique classes, one body alignment class, one pointe readiness, one pre-pointe, and one modern class per week » Tue. 4:30 to 7:30 pm » Thur. 4:30 to 7:30 pm » Sat. 10:30 am to noon $279 per month$2,790 full year tuition Level 4 Three 1.5 hour ballet technique classes, one body alignment class, two pointe classes, one modern, one character and one pointe conditioning class per week » Tue. 4:30 to 7:30 pm » Thu. 4:30 to 7:30 pm » Fri. 5:00 to 7:00 pm $311 per month$3,110 full year tuition Optional Electives: Level 3 Select payment type AND day/time One Elective ($40 per month)One Elective ($400 full year)Two Electives ($80 per month)Two Electives ($800 full year)» Tap (Mon. 7:00 - 8:00 pm)» Character (Fri. 6:00 - 7:00 pm) Optional Electives: Level 4 Select payment type AND day/time One Elective ($40 per month)One Elective ($400 full year)» Tap (Mon. 7:00 - 8:00 pm) Total Parent/Guardian Contact Information Parent/Guardian First Name * Parent/Guardian Last Name * Parent/Guardian Email * Address * City * State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampsire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Primary Cell/Home Phone # * Secondary Cell Phone # Student's Age (as of today) * Student's Date of Birth * Student's Grade Level * Emergency Contact * Relationship to Student Emergency Contact Cell Phone # * Payment Options Ballet Virginia International is careful about keeping your personal financial information private and secure. Therefore, someone from our staff will contact you within 24 to 48 hrs during BVI's regular business hours for your credit card information in order to complete the registration process. Please note the registration form received via electronic processing is not complete until payment has been received and secured. (Choose one below by checking a box) Payment in Full If selected, a one-time, full tuition payment is due at the time of registration for 2018-2019 year. Payment in Full Auto-pay Plan* If selected, your bank card will be charged immediately for the first month’s tuition and registration fee (if applicable) at the time of registration and then at the beginning of each month from 10/1/18 through 6/1/19. Automatic Electronics Funds Transfer Authorization Fees: * Late Payment: $10.00 (each late payment) * Insufficient Funds: $25.00 (returned checks & declined credit cards) Electronics Funds Transfer Authorization I (we) herby authorize Ballet Virginia International to initiate bank card charges to the swiped card on file. To properly affect the cancellation of this agreement, I (we) are required to give 10 days written notice. To update or change your credit card on file at any time, you must do so at the studio office. All information will be kept confidential and stored in a secure environment. If your payment method is declined, we will contact you immediately and you will have until the 5th of the month to provide payment. Late payment fees of $10 and insufficient funds fees of $25 will be applied. Billing email address: Billing Zip Code: Name as it appears on bank card: MEDICAL AND LIABILITY RELEASE I understand that Ballet Virginia International will not be held responsible for any bodily injuries sustained while on the premises or for loss or damage to any personal items brought on the premises by students or their families this shall include, but not be limited to any and all activities in the dance school, directly or indirectly around the dance school, or in any other place so designated by Ballet Virginia International including performances and outreach activities. In the event of an emergency, I hereby give authority to Ballet Virginia International’s representatives to obtain necessary emergency medical treatment for myself or my child, to hospitalize, to secure medical treatment, and/or to order an injection, anesthesia, or surgery for myself or my child as deemed necessary with the understanding that the family will be notified as soon as possible. I understand that my insurance coverage for myself or my child will be used in the event medical intervention is needed and that I am responsible for the payment of any/and all medical services. I understand all reasonable safety precautions will be taken at all times by Ballet Virginia International and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Ballet Virginia International, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the undersigned. I understand that in the instruction of dance and in particular, ballet, physical manipulation of a student by the instructor may occur. This physical manipulation will occur only when assisting the student in the proper alignment and execution of dance steps. I hereby authorize the instructors to physically manipulate myself or my child in order to assist in the proper alignment and execution of dance steps. MEDICAL AND LIABILITY RELEASE: Please check this box to acknowledge you have read, understand and agree to the above: * PHOTO RELEASE By initialing below, I hereby irrevocably grant and convey to Ballet Virginia International all rights, titles and interests in and to record my name, image, voice, statements and/or writings including any and all photographic images and video or audio recordings made by Ballet Virginia International. I further irrevocably grant to Ballet Virginia International, its advertisers, customers, agents, successors and assigns, unrestricted rights to use the above mentioned sound, still, or moving images in any medium, including posting on the Internet and World Wide Web, for educational, promotional, advertising, or other purposes without limitation consistent with the mission of the Academy. I agree that all intellectual property rights to the sound, still, or moving images belong to Ballet Virginia. I voluntarily waive the right to inspect or approve such images and waive my right to any royalties, proceeds or other benefits derived from such photographs or recordings. This release is effective on the date this form is submitted and will remain in effect indefinitely. If individual is less than eighteen (18) years of age, his/her parent or legal guardian must agree below. PHOTO RELEASE: Please check this box to acknowledge you have read, understand and agree to the above: * WITHDRAWAL/REFUND POLICY All tuition is non-refundable. Refunds will not be made, except in the case of serious illness or injury, verified by a doctor’s certificate. If a student is dismissed from the Academy because of unacceptable behavior, no tuition will be refunded. Ballet Virginia International reserves the right to deny any refund request. Should a tuition refund be issued, the registration fee will not be refunded. If a student wishes to withdraw from the Academy, the Academy Directors must receive, in writing, notification that the student is withdrawing. The parent or guardian is responsible for all tuition payments due up until the point the Academy receives written notification of the withdrawal. WITHDRAWAL/REFUND POLICY: Please check this box to acknowledge you have read, understand and agree to the above: * Support BVI with a donation Support BVI by adding a small tax deductible amount to your tuition payments Add $5 per month*Add $10 per month*Add a one time donation of $25 Add a specific donation per month*: Add a one–time donation of: *through 6/1/19 BVI is a 501(c)(3)nonprofit corporation registered with the Virginia Office of Consumer Affairs. Confirm that you are not a bot * Share this: Facebook Twitter