Vermont Ballet Theater School Online Registration

Online Student Registration Form

If you do not wish to submit online, you may simply print your completed form and send it with payment and signature to VBTS by mail.
In order to process the form the first month tuition is due along with the registration fee.

Academic Year 2011-2012 (September 2011-June 2012) A $25.00 non-refundable fee will be charged when submitting this form. Family maximum of $40.00 .
Student Information
Full Name:		D.O.B.: Gender: School Grade:
Previous Dance School:		# of classes per week: Years of study:


Parent/Guardian Information(If applicable)
Mother:	Home #:	Work #:	Mobile:
Father:	Home #:	Work #:	Mobile:
Emergency Contact:	Home #:	Work #:	Mobile:


Address Information
Student Address:		Billing Address(if different)
City/State/Zip:		City/State/Zip:
Contact Email:		Billing Email(if different from contact email):


Class Registration
Campus Name	Essex	Shelburne

Class Name	Class Day(s)	Class Time	Class Name	Class Day(s)	Class Time
1.			6.
2.			7.
3.			8.
4.			9.
5.			10.

Academic Year Tuition Information

Young Dancers
Class	Lessons per week	Duration	Monthly Installment
Tots, CID, CID II, CIB	1	Up to .75	$ 56.00

Pre-Professional Ballet Technique
Class	Lessons per week	Duration	Monthly Installment
Ballet I	1	1 hr.	$ 60.00
Ballet II	2	1.25 hrs.	$128.00
Intermediate I	2	1.25 hrs.	$128.00
Jr. Intermediate	3	1.25-1.5 hrs.	$192.00
Intermediate II	3	1.5 hrs.	$192.00
Intermediate III	3	1.5 - 2 hrs.	$192.00
Intermediate IV	4	2 hrs.	$264.00
Advanced B	4	2 hrs.	$264.00
Advanced A	4	2 hrs	$264.00
Non-Members-additional classes
Pointe Class		1 hr.	$ 60.00
Variations Class		1.5 hrs.	$ 68.00
Modern		1.5 hrs.	$ 68.00
VBT/VYB Members Only-additional classes (discounted)
VBT/VYB Extra Class	1	1.25-1.50 hrs.	$ 52.00
Pilates	1	1	$ 44.00
Pointe Class	1 or 2	1	$ 44.00 per class
Variations Class	1	1.5	$ 52.00
Modern	1	1.5	$ 52.00

Teen & Adult Ballet Only
Class Cards		Duration	Monthly Installment
10 Class Card		1 hr.	$130.00
10 Class Card		1.25 hrs.	$140.00
10 Class Card		1.5 hrs.	$150.00
Yoga & Pilates		Duration	Class Card
10 Class Card*		1-1.25hrs.	$110.00
*$12.00 Drop-In fee
Body Transformer
10 Class Card*		1 hr.	$ 70.00
*$10.00 Drop-In fee
Jazz/Hip-Hop/Tap
Class		Duration	Monthly Installment
Any Level		1hr.	$ 60.00

Tuition Payment Schedule Worksheet - Choose which schedule you will use.

#1. Monthly Installments *		Enter correct amounts	#2. Year Paid in Full *		Enter correct amounts
Class Installment Fee			Class Installment Fee			Payable by check or credit card.(Add 2% credit card fee.)
or	10 Class Card		x	10 (Month Year)
+	Registration Fee		+	Registration Fee
			+	Fees
Convenient monthly payment envelopes will be mailed after receipt of registration form.			=	Total Tuition Due
*Costumes and performance fees will be billed for separately.

Payment Information
VISA Mastercard Discover Check
Name on Card Account#	Ex. Date Security Code
I authorize VBTS to charge my account for the amount listed in the worksheet above.

Yes, VBTS has my permission to automatically deduct monthly tuition from my credit card.

Please read the following VBTS Policies information. You must agree to the terms in order for your registration to be submitted.

VBTS Policy Acknowledgment and Release of Liability

"I have read the Vermont Ballet Theater School program materials and agree to abide by the protocol and etiquette requirements. I have examined the Academic Year Tuition payment policies. I understand them and agree to abide by their terms. I am aware that ballet dancing and the gymnastic exercise associated with it place unusual stress on the body and carry with them the risk of physical injury. On behalf of myself and/or my child, I assume the risk and agree that Vermont Ballet Theater school, Board of Directors, faculty and any of the chaperones and agents shall not be liable in any way for any injuries sustained, or loss of property at the school or any of its functions."

By checking this box, you agree to the terms listed in the VBTS Policy Acknowledgment and Release of Liability and will be dated as the day the registration form is submitted to VBTS. I agree.

Printed versions must sign here agreeing to the terms listed above. Signature & Date ______________________________________________

Mailing Address: P.O. Box 8147 Essex, Vermont 05451 Phone: (802)878.2941 FAX: (802)879.7001