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.

Summer Registration 2010
Student Information
Full Name: D.O.B.: Gender: School Grade:
Previous Dance School: 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:
 
Summer Class & Camp Information
Young Dancers    
Class Session Campus Session Cost Register
Tots Session 1
July 5 – July 28
(4 weeks) 		Essex $56.00
CID
CID II
CIB
CID Session 1
July 6-July 22
(3 weeks only)		 Shelburne $45.00
CID II
CIB
Tots Session 2
August 4-25 		Shelburne $56.00
   
Pre-Professional Ballet Technique  
Class Session Campus Session Cost Register
Ballet I Session 1  
June 29-July 22
(4 weeks)

 Session 2  
July 27-Aug19
(4 weeks)		 Essex $60.00 1
2
Ballet II Session 1  
June 29-July 22
(4 weeks)		 Session 2  
July 27-Aug19
(4 weeks)		 Essex $63.00 1
2
Intermediate Session 1  
June 29-July 22
(4 weeks)		 Session 2  
July 27-Aug19
(4 weeks)		 Essex $63.00 1
2
Intermediate Ballet Session 2 ONLY
July 27-August 19
(4 weeks)		 Essex $64.00
1 class/week
Choose Day		 T
Th
  $120.00
2 classes/week
Advanced Ballet

Session 2 ONLY
July 27-August 19
(4 weeks)

Please choose Tuesday or Thursday if taking only one class per week.

Essex $64.00
1 class/week
Choose Day 		T
Th
  $120.00
2 classes/week
         
Adult Ballet Only        
        Register
Adult Ballet Session 1
June 28-July 21
(4 weeks)

 Essex. $64.00
Session 2
July 26-August 18 (4 weeks)
Choose level: Beginner, Intermediate or Advanced.
 Beg.
Int.
Adv.
         
Yoga & Pilates Campus Session Cost Register

Int/Adv Pilates

 Essex $12.00 per class
Mindfulness Flow Yoga Essex $12.00 per class
Power Yoga Essex $12.00 per class
       
Jazz, Lyrical & Tap      
Class Session Campus Session Cost Register
Lyrical /Contemporary Jazz -Beginner
Session I
August 4-August 25
(4 weeks)		 Shelburne $ 64.00
Jazz & Tap
Lyrical /Contemporary Jazz -Intermediate
         
Summer Intensives & Camp        
Camp Session Date Campus Session Cost Register
Mini Summer Intensive
 June 14-18 Monday-Friday Essex $95.00/week
         
Dance Camp with Mel Hendrix
 June 21—June 25 Monday—Friday
“Cinderella Camp”
9:00-10:00 am Ages 3 & 4
 Essex $80.00/week
“Nutcracker Camp”
10:30-11:30 am Ages 5 & 6  
         
Dance Camp with Mel Hendrix
 June 28 - July 2 Monday—Friday
“Sleeping Beauty Camp”
9:00-10:00 am Ages 3 & 4
 Essex $80.00/week
“Firebird Camp”
10:30-11:30 am Ages 5 & 6
         

Dance Camp with Annette Urbschat

June 21-June 25 Monday-Friday
“Arabian Nights Camp”
9:00am-12:00pm Ages 6 & 7

 Shelburne $195.00
         
Dance Camp with Annette Urbschat

July 26-July 30 Monday-Friday
“Nutcracker Camp”
9:00am-12:00pm Ages 4 & 5

 Shelburne $195.00
   
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 ______________________________________________
Unsigned applications will not be registered.

Mailing Address: P.O. Box 8147 Essex, Vermont 05401 Phone: (802)878.2941 FAX: (802)879.7001
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