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.

Academic Year 2009-2010 September 2009-June 2010 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:
Email:		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	$ 52.00

Pre-Professional Ballet Technique
Class	Lessons per week	Duration	Monthly Installment
Ballet I	1	1 hr.	$ 55.00
Ballet II	2	1.25 hrs.	$116.00
Intermediate	2	1.25 hrs.	$116.00
Jr. Intermediate	3	1.5 hrs.	$172.00
Intermediate II	3	1.5 hrs.	$172.00
Intermediate III	3	2 hrs.	$190.00
Intermediate IV	5(includes variation)	2 hrs.	$288.00
Advanced A/B	5(includes variation)	2 hrs.	$288.00
VBT/VYB Members Only -Extra Classes	1	1-2 hrs.	$ 49.00

Young Adult
Class - Per Lesson/ per week		Duration	Monthly Installment
YAB I		1.25-1.5 hrs.	$ 60.00
YAB II		1.25-1.5 hrs.	$116.00

Adult Ballet Only
Class Cards		Duration	Monthly Installment
10 Class Card		1 hr.	$120.00
10 Class Card		1.25 hrs.	$130.00
10 Class Card		1.5 hrs.	$140.00
Yoga & Pilates		Duration	Class Card
10 Class Card		1hr 25min	$110.00

Jazz
Class		Duration	Monthly Installment
Any Level		1hr.	$ 55.00
Any Level		1hr. 25min.	$ 56.00

Other Classes
Class		Duration	Session Cost
Ballroom Dancing Oct. 4 - Nov.22, 2009 -8 weeks		1.5 hrs.	175.00 per couple

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

Monthly Installments		Enter correct amounts		Year Paid in Full		Enter correct amounts
Class Installment Fee			Costumes and performance fees will be billed for separately.	Class Installment Fee			Full year tuition, 5 % discount if paid in full by June 15th, 2009. Payable by check or credit card. Costumes and performance fees will be billed for separately.
+	Registration Fee			x	10 (Month Year)
=	First Installment Due			x	0.95(5% Discount)
				+	Registration Fee
				=	Total Tuition Due

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

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 05401 Phone: (802)878.2941 FAX: (802)879.7001