Presser Arts Center

Students Name *

First Name

Last Name

Date

Date of birth

MM

DD

YYYY

Student Phone

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Parent/Guardian Phone

(###)

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Parent/Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

First Name

Last Name

Emergency Contact Phone

(###)

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Scholarship Information

Financial Assistance is available for all PAC programming. Scholarships are limited. A Scholarship Application Form must be filled out and on file with all the requirements completed to be considered for scholarship. If for any reason the scholarship recipient is unable to attend the program or camp, CANCELLATION must be made prior to the program or camp beginning. Failure to alert the Administrator of a possible vacancy will result in a LATE CANCELLATION FEE OF $50 and all future scholarship requests from that person will be flagged as “cautious consideration”. PAC incurs expenses for every program such as materials, teaching artists, equipment, consumables, rentals, transportation, etc. and when an empty spot in a program from a no-show or late cancellation occurs that could’ve been filled it impacts the income and viability of that program for the future. We ask that our scholarship applicants understand that a late cancellation or no-show will leave a void in the PAC program.

yes, student will be applying for a scholarship

no, student will NOT be applying for a scholarship

Media permission

I give permission to PAC to use any photographs or video of participant in Promotional materials, commercials and website

Yes

No

Medical *

I am aware that dancing, and the exercises associated with it, place unusual stresses on the body, and carry with them the risk of physical injury. On behalf of my child and myself (and if I am no longer a minor, on my own behalf), I assume the risk and agree that Presser Arts Center Ballet shall not be liable in any way for injuries sustained during the attendance at Presser Arts Center Ballet or any of its related functions. I grant, my child, or ward, the permission to participate in Presser Arts Center Ballet semester. I hereby release and discharge the Presser Arts Center Ballet, its agents, employees, and officers from all claims, demands, actions, judgments, and executions which the undersigned’s heirs, executors, administrators or assigns may have, or claim to have against Presser Arts Center Ballet, its successors, or assigns, for all personal injuries caused by, or arising from, the above described activities, or any activities related thereto. Further, I grant Presser Arts Center Ballet, its agents and employees, permission to authorize any emergency medical treatment that may be required for my child, or ward, during the school semester.

yes

I need more information

Release: I, the undersigned parent/guardian of this student, a minor, do hereby release and discharge PPAC from any and all claims for personal injuries. *

Yes

Behavior Contract *

Behavior Contract * BEHAVIOR CONTRACT SUMMER FINE ARTS CAMP AND PAC BEHAVIOR CONTRACT RULES FOR REHEARSAL SPACE AND THEATRE FACILITY I know that participating in Summer Camp is a privilege and I will abide by the following: • Respect all personnel-directors, teachers, artistic team members, parents, other students, and facility representatives at all times. • Use honoring language and actions; I will not gossip, name-call, use profanity or inappropriate words or actions. • Treat property and facility with care. • Dress modestly and appropriately; I will not wear clothing that will be distracting-this includes for girls: short pants that are shorter than the length of my arm, no bare midriffs or cleavage showing. Boys: pants must be worn no lower than hips, and no underclothing showing, no tee shirts with inappropriate logos or pictures. No sandals or flip-flops, I must wear closed-toe shoes at all times. • Be appropriate in my relationship choices and actions; I will avoid the use of drugs, alcohol, cigarettes, and overt physical contact with others. • I will not leave the building without permission of the Director or Assistant Director. • I will check out with the Director or Assistant Director before I am released to go home. A parent/guardian must come to the door to pick me up. • My parent(s) or guardian must provide a note if someone else is taking me home. • I will TURN OFF my cell phone and all other electronic devices prior to entering class each day and KEEP THEM OFF or KEEP THEM AT HOME. I understand that Presser Performing Arts is not responsible for any lost or stolen property. At the Theatre Facility: I understand that • I do not touch anyone's props except my own, unless directed to do so. • No eating, drinking (except water) and no horseplay in costume • Costumes are hung up neatly on hangers every night without exception. Dressing rooms are left clean and orderly. We are guests in the facilities we are using. Cast members will receive one warning. On the second warning, parents will be called for a conference. Any further violations, cast member will be dismissed from the cast. I understand that behavior problems may affect future participation in Presser Performing Arts Center. I have read the above rules and reviewed them with my child. I agree to hold Presser Performing Arts Center, and/or their assignee's, harmless in the event of an injury or accident. I consent to surveillance video cameras in all public spaces of Presser By completing my name below I agree to all of these terms and conditions. Type Students Name Below

First Name

Last Name