Date_______________

Summer Registration Intake Form

Student Last Name _____________________________ Student First Name ____________________________ MI_________

Date of Birth ______________ Age_________ Grade _________ Gender______ Current School_______________

Name Parent Guardian ______________________________ Email ____________________________________________

Parent/Guardian Cell Phone ( ______ ) ________-____________ Home Phone ( ______ ) ________-____________

Students Address__________________________________________ City _______________________ Zip ______________

Emergency Contact Name _________________ Phone ( ______ ) ________-____________ Relation____________________

Any known medical problems, allergies or medications being taken?______________________________________________

Previous Dance Training Yes No Years of Training _____ Name of School/Studio_________________________

How did you hear about Balance Dance Studios? ______________________________________________________________

BY REGISTERING AND ATTENDING ANY PROGRAM OR CLASS AT BALANCE, YOU ARE

AGREEING TO THE TUITION & REFUND POLICY, RELEASES, & INDEMNIFICATION
AGREEMENT. IF YOU HAVE NOT REVIEWED AND SIGNED THE AGREEMENT PLEASE
REQUEST A FORM FROM THE FRONT DESK.

CLASSES
(Check one)
Please list all classes student wishes to be enrolled in Day/Time 1 Hr. 1.5 Hr. Cost
____________________________________________ ______________________ $___________
____________________________________________ ______________________ $___________
____________________________________________ ______________________ $___________
____________________________________________ ______________________ $___________
____________________________________________ ______________________ $___________
____________________________________________ ______________________ $___________
Total $___________

CAMPS, WORKSHOPS & INTENSIVES

Please list all Camps, Workshops and/or Intensives Date (Week Starting) Cost
_________________________________________________ ______________________ $___________
_________________________________________________ ______________________ $___________
_________________________________________________ ______________________ $___________
_________________________________________________ ______________________ $___________
_________________________________________________ ______________________ $___________
_________________________________________________ ______________________ $___________
Total $___________

PLEASE REVIEW AND SIGN BACK SIDE

4544 South Lamar Blvd, Building 200 & 300| Austin, TX 78745 |info@balancedancestudios.com | 512.215.8727

 Tuition and Refund Policy, Releases, and Indemnification Agreement

SUMMER CLASS TUITION AND REFUND POLICY: Summer classes do not require a registration fee; however, full
summer tuition payment must be paid in full in order to be officially registered, unless alternate arrangements have
been authorized through Balance Dance Studios or Tapestry management. Tuition pricing is available below, online or
at the front desk, and is based on the students total number of enrolled classes. Summer class pricing is based on a
9-week schedule and is not prorated or refundable. Credit is not given to students with absences; however, a similar
class may be attended as a make up anytime within the 9-week summer session.

SUMMER CAMP REGISTRATION FEES AND REFUND POLICY: -Summer camp, workshop, and intensive
registration fees are due in full at the time of reservation. You may purchase an unassigned camp or
workshop and enroll into a specific camp or workshop at a later date; however, Balance cannot guarantee
future availability. Summer program registration fees are non-refundable. If cancellation is made with 14
days or more notice of the camp, a credit may be transferred to an alternate summer camp - *full day and
half day summer camps only).

AUTHORIZATION OF EMERGENCY MEDICAL CARE: I hereby authorize the staff and director, representing Balance
Dance Studios/Tapestry, to give consent for any and all necessary emergency medical care for me or any dancer I
am enrolling with Balance Dance Studios/Tapestry, while in the custody of Balance Dance Studios or Tapestry
personnel. I also hold Balance Dance Studios & Tapestry and any other BDS/TAPESTRY personnel harmless in such
an event. Pertinent medical conditions my child(ren) has/have:______________________________________________.
PHOTO/MEDIA/EMAIL RELEASE: I give Balance Dance Studios & Tapestry the absolute right and permission to use
my childs photograph(s) in its promotional materials and publicity efforts. I understand that the photograph(s) may
be used in a publication, print ad, direct-mail piece, electronic media (e.g. video, Internet), or other form of promotion. I
release Balance Dance Studios/Tapestry, the photographer, their offices, employees, agents, and designees from
liability for any violation of any personal or proprietary right I may have in connection with such use. Additionally, I will
make no monetary or other claim against Balance Dance Studios & Tapestry for the use of the
photograph(s)/video(s). Additionally, I am aware and consent to the use of password protected webcam online
access to my childs dance studio used only for the purposes of family viewing of dance sessions. Balance does not
share clients personal information with any other company or organization outside of Balance Dance Studios or
Tapestry owned entities. & Tapestry uses client email address provided at the time of registration as a means to
communicate important studio details, including but not limited to, studio closures, account related communication,
studio related events and news. I provide Balance Dance Studios & Tapestry permission to utilize my email in the
above-mentioned ways.

ASSUMPTION OF RISK, WAIVER OF LIABILITY AND INDEMNIFICATION AGREEMENT: I am aware that dancing, and
the exercises associated with it, can place stress on the body, and carry with it 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 Balance
Dance Studios & Tapestry shall not be liable in any way for injuries sustained during attendance at Balance Dance
Studios & Tapestry or any of its related functions. Student or Guardian/Parent of Student understands and
acknowledges that Balance Dance Studios & Tapestry is not an insurer of Student's behavior, actions or participation
in the program/classes, and that Balance Dance Studios & Tapestry assumes no liability whatsoever for personal
injuries or property damages to Student or to third persons arising out of participation in the program activities,
classes, or any activities related thereto. Student or Guardian/Parent hereby agrees to release, waive, covenant not
to sue, indemnify and hold harmless Balance Dance Studios/Tapestry, its owners/directors, teachers, employees, or
the owners of the location 4544 S Lamar Blvd, Austin, TX 78745 (Bldg. 200 & 300), from any and all liability, claims,
demands, judgments, actions, executions and causes of action whatsoever. I UNDERSTAND THAT I AM WAIVING MY
RIGHT TO TAKE LEGAL ACTION INCLUDING FILING A LAWSUIT FOR PERSONAL INJURIES TO MY CHILD(REN)
AND/OR MYSELF.

Name of Student _____________________________________________________

Name of Parent/Guardian _____________________________________________
Signature of Parent/Guardian __________________________________________ Date____________________

4544 South Lamar Blvd, Building 200 & 300| Austin, TX 78745 |info@balancedancestudios.com | 512.215.8727

 9-Week Summer Youth Class Tuition (June 12 th - Aug 12 th )

9-week Summer 9-week Summer 9-week Summer

Hours/week Hours/week Hours/week
Tuition Rate Tuition Rate Tuition Rate
1 $147.00 3.5 $514.50 6 $714.00
1.5 $220.50 4 $588.00 6.5 $729.75
2 $294.00 4.5 $630.00 7 $745.50
2.5 $367.50 5 $672.00 7.5 $756.00
3 $441.00 5.5 $693.00 8 $761.25
Each additional hour of classes beyond 8 will be charged at a rate of $10/class for the 9-week summer session

Summer Youth Camp, Workshop & Intensive Schedule and Pricing

Half Full Workshops
Week Starting Camps Intensive
Day Day 10-15 yrs Int

6/12/17 Dinosaur Adventures X Drill *Ballet Intensives

6/19/17 Cupcakes & Cartwheels X Acro

6/26/17 Princess Party X Musical Theater June aXis Intensive

7/3/2017 (3-day Fairy Pirates (prorate 3
X
camp July 5-7) days: $135)

7/10/17 Once Upon a Time X Contemporary/Improv Reel Experience

7/17/17 Funky Monkey X Jumps & Turns

7/24/17 X Stretch & Strength Open Level

7/31/17 Broadway Babies X Hip Hop

8/7/17 Cirque de Balance X August aXis Intensive

Half Day Camps (Ages 2-5) Intensives

$225 Jr. Ballet Intensive *(L3 pre-qualified, L2
M-F 9a-1p M-F 10:30a-3:30p $295
($200 before April 1st) approval needed)
Full Day Camps (Ages 6-11) Senior Ballet Intensive *(L4 & L5 only) M-F 10:00a-3:30p $395

M-F 9a-4p $350 AXIS Intensive Int (Ages 8-11) M-F 11a-4p $325
($325 before April 1st)
Afternoon Workshops (Ages 10-15 Int) AXIS Intensive Adv (Ages12+) M-F 9:30a-3:30p $450

T-TH **12:30p-3:30p $150 Reel Experience (Int./Adv) M-F 10a-3:00p $395

*Students new to Balance or current students who have not recieved a ballet level evaluation are required to schedule an adution class in order to enroll
into a summer ballet intensive. Email ballet@balancedancestudios.com for more informatin or to schedule an audition class.
**An optional 1- hour pre-workshop session offered on Tuesdays 11:30am-12:30pm for new students ($15). Contact the Balance front desk to register.

4544 South Lamar Blvd, Building 200 & 300| Austin, TX 78745 |info@balancedancestudios.com | 512.215.8727