The Stevan Grebel Center for Dance and The

The Stevan Grebel Center for Dance and the

Alabama Youth Ballet Company

Student Information

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PLACE PHOTO HERE

Student Name (Last First M.I): ______

Date of Birth: ______Current Age: ______

Student’s Social Security Number ______-______-______

Height: _____ / Weight: ______/ Eye Color: ______/ Hair Color: ______

Returning AYBC Student? ______Yes ______No

Previous Group Placement?

Lower School __Upper School __Senior Company __ Junior Company__Apprentice___

Name of Parent(s)/Guardian: ______

Address: ______

Street City State Zip ______

Parent Home #: ______Parent Cell #: ______

Parent Work #: ______Student Cell #: ______

Parent Work 2 #: ______

Student E-mail: ______

Parent E-mail: ______(many updates are sent through e-mail, please write legibly)

Name of School: ______

City: ______

Type of schooling: Public ______Private ______Home Schooled ______

Current Grade (i.e. 4th, 10th): ______Present GPA (letter or number): ______

Health: Excellent _____ Good _____ Fair _____ Poor _____

Allergies: ______Back Problems? ______

Breathing or stamina problems: ___Yes ___No, Please explain: ______

Severe headaches: ___Yes ___No, Please explain: ______

Problems concentrating: ___Yes ___No, Please explain: ______

Any other medical conditions: ______

Years of previous training: ______How many hours a week do you dance now? ______

Major training was in: (ballet, tap, jazz, modern, gymnastics) ______

Present Dance School: ______

How did you hear about the Stevan Grebel Center for Dance and the Alabama Youth Ballet Company? ___Friend ____Letter ___Radio ___ Newspaper ___TV ___Current Studio ____Web Site

Person Responsible for Tuition______

Relationship: ______

Student signature______Date ______

Parent(s) / Guardian signature ______Date ______

Office Use Only:

Current Group Assignment: ______

Grebel Dance and The Alabama Youth Ballet Company

CONTRACT

This Academy Contract is by and between AYBC and/or Grebel Dance and the parent(s) or guardian(s) of Student (as both terms are defined below in this contract).

AYBC or GREBEL DANCE STUDENT

Name (Last, First):______

Date of Birth (Month/Day/Year):_________

___ To enter Summer Program Year 200__

___ To enter Academic Year 200___ - 2000___ Academic Grade______

WHEREAS, The Alabama Youth Ballet Company and Grebel Dance Academy are operated by The Stevan Grebel Center for Dance, LLC, a self-sustaining Alabama corporation located at 102 Commerce Parkway, Pelham, Alabama 35124 (the “Company”).

WHEREAS, The Alabama Youth Ballet Company, Grebel Dance Academy and The Stevan Grebel Center for Dance,LLC, and its directors, officers, employees, agents, licensees, successors and/or assigns, are hereafter sometimes individually and collectively referred to as the “AYBC” or “Grebel Dance.”

NOW IN CONSIDERATION of the premises hereunder and other valuable consideration the receipt and sufficiency of which are hereby acknowledged, I/We (individually or jointly), as parent/legal guardian of the above-named student (hereinafter “Student”), agree to the following:

1. Overview. I/we have enrolled the above-named student at Grebel for dance training. It is understood that from time to time it will be necessary for Grebel Dance or AYBC to arrange for the services of independent contractors to manage and/or operate AYBC as a dance training and instruction institute. I/We agree to hold harmless, discharge and release AYBC and GREBEL DANCE from any and all liability for injury, loss, damage, obligation, expense, or penalty sustained by Student arising out of or in connection with the Student’s participation at Grebel Dance;

2. Liability. I/we acknowledge that Student will be physically touched from time to time during his/her dance training and instruction and that I/we will not hold Grebel Dance liable for such physical touching. In addition, Grebel Dance will not be held liable for and will be held harmless from any and all liabilities, losses, injuries, damages or expenses related to the Student’s dance training at AYBC or participation in AYBC sponsored events.

3. Use of Performances and Copyright. I/we authorize Grebel Dance to photograph, film, videotape, record or otherwise capture in any media whatsoever now known or hereafter devise the Student’s dance training, instruction, and performances and to use such recordings for instruction, promotion, publicity and broadcast uses. All ownership (including copyright) as well as all other rights, title and interest in and to these recordings shall belong exclusively to Grebel Dance. I/We further grant Grebel Dance the right to use the Student’s name, bio, portrait, picture, likeness and any recordings thereof for the purposes of advertising, publicizing, and promoting AYBC and Grebel Dance;

4. Consent for Emergency Treatment. In cases of emergency, Grebel Dance is authorized to arrange for medical services for the Student and I/We consent to appropriate medical and surgical service recommended by licensed medical professionals. I/We accept full responsibility for all costs of said medical care and any emergency treatments. Grebel Dance will not be responsible for the cost of any medical care or emergency treatments but it may accept billing in its name only to facilitate submission of medical insurance claims for the Student, if applicable, or for the prompt forwarding of bills to me/us; I/we agree that Grebel Dance will not be held liable for authorizing medical treatments for the Student pursuant to my/our authorization in this paragraph and I/we hereby waive all claims whatsoever in connection with such medical

treatments. I/We agree that Grebel Dance will not be held liable for and agree to hold Grebel Dance harmless from any and all liabilities, losses, injuries, damages or expenses related to the Student’s participation in any of the activities at Grebel Dance and from the Student’s enrollment at Grebel Dance generally. Any and all claims against Grebel Dance are waived. Any damage and/or harm by the Student will be the responsibility of the parent/legal guardian;

5. Consent to Participate in AYBC or Grebel Dance Activities. I/we authorize the Student to participate in any AYBC or Grebel Dance sponsored or related activities or excursions, whether held on Grebel Dance grounds or otherwise, including swimming, recreational, educational, and cultural activities. In arranging for such activities or excursion with third parties I/We acknowledge and agree that Grebel Dance is acting as the agent for the Student;

6. Consent to Participate in AYBC or Grebel Dance Productions. I/we grant permission for the Student to participate in the dance recitals and productions at Grebel Dance, or other locations for the duration of his/her enrollment in Grebel Dance with full knowledge of the risks inherent in dancing or related activities. Accordingly, I hereby release Grebel Dance from any and all liabilities arising out of my child’s participation in any rehearsal and/or performance;

7. Mandatory Minimum Attendance. I/We understand that my/our child is obligated to attend no less than one to four classes per week depending on the program in which they are enrolled. If the AYBC Student misses three rehearsals for an upcoming performance, the Student will be suspended from the upcoming performance on the fourth missed rehearsal. Failure to attend class for 2 weeks after an injury or illness will result in susepension from the upcoming performance.

8. Student Code of Conduct. Any breach of the signed Student Code of Conduct will be reviewed by the Artistic Director, Director and Staff and may result in the Student being suspended from participating in AYBC or Grebel Dance activities and/or being expelled from Grebel Dance indefinitely.

9. Tuition. That I/we the undersigned parent(s), guardian(s) or guarantor(s), agree to timely pay the tuition and fees the first day of class each month, performance and costume fees are due at the time of audition/casting;

10. Payment of Tuition. I/We hereby acknowledge that my/our signature on this contract obligates me to pay the specified monthly tuition no later than the first day of class of each month. I/We understand an additional $15 per class will be charged for every additional class in excess of specified enrollment. I/We understand we are responsible for the tuition unless/until this enrollment is canceled with a written 30 days notice. I/We understand we are responsible for payment of the final month’s tuition. There is no refunding of fees and tuition or transferring of fees and tuition to another session.

11. Method of Payment. Payments of the Total Payment Obligation or any other fees due to Grebel Dance may be made by personal check, money order or cash. Should a personal check be returned to the School due to insufficient funds, Grebel Dance may require that all future payments be made in cash, cashiers check or certified check. A service charge of $25 per returned check will be assessed to cover processing charges.

12. Late Payment Fees. In the event your child attends class and that month’s tuition has not been paid in advance, a pro-rated fee per unpaid class, plus a $5.00 late fee for each unpaid class will be levied.

13. Your tuition obligation remains binding even in the event your child is used in a production affiliated with Grebel Dance during the term of this contract.

14. To enroll your student, you must sign this contract and return it to Grebel Dance.

Print Name of Parent/Legal Guardian

Parent/Legal Guardian Signature

Date:______

FOR YOUR RECORDS

Below are pertinent points that you have just signed reflecting our mutual agreements concerning your child’s training as a dancer at The Stevan Grebel Center for Dance which you may wish to refer to from time to time.

7. Mandatory Minimum Attendance. I/We understand that my/our child is obligated to attend no less than a total of 1-4 Core classes a week.

10. Payment of Tuition. I/We hereby acknowledge that my/our signature on this contract obligates me to pay the monthly tuition which is specified per month no later than the first day of class of each month. I/We understand we are responsible for the tuition unless/until this enrollment is canceled with a written 30 days notice. I/We understand we are responsible for payment of the final month’s tuition.

13. Your tuition obligation remains binding even in the event your child is used in or suspended from a production affiliated with Grebel Dance during the term of this contract.

Stevan Grebel Center for Dance and Alabama Youth Ballet Company

Dear Parents or Guardians:

The following Authorization and Extra-Curricular Activity Form must be filled out and returned to the School or your child will not be permitted to engage in the activities arranged by the Stevan Grebel Center for Dance or the Alabama Youth Ballet Company (Grebel Dance).

AUTHORIZATION AND RELEASE

The Undersigned, as the parent(s) having legal custody or as the legal guardian(s) of ______, a minor, do hereby give permission, consent and authorization for such minor to participate in AYBC’s or Grebel Dance’s Extra-Curricular Activities during the period of enrollment in the Stevan Grebel Center for Dance. Subject to the exceptions set forth below, the Undersigned (i) assume all risk associated with participation in the above Activities, including transportation to and from the Activities; (ii) agree to indemnify, defend, and hold harmless Grebel Dance, it’s agents, employees, officers, directors, successors and assigns, including the driver of any vehicle in which the above child may be riding while engaged in the Program and fully and forever release and discharge such parties from any and all claims, demands, actions, causes of actions, suits, controversies, obligations and liabilities of any kind and nature whatsoever (collectively referred to as Claims) relating to personal injury or property damage sustained, incurred, or caused by said minor aforedescribed program or any other events and occurrences while said minor is engaged in the Program or any activity related thereto.

The foregoing assumption of risk, aforement to indemnify and release shall further be inapplicable to and of no force and effect for any and all Claims asserted against any third party independent contractor performing services for compensation in connection with the Activities, except to the extent and amount that such third party independent contractor has a valid right, and claim for contribution, reimbursement or indemnity which is not covered by the above described insurance and is asserted against Grebel Dance, it’s agents, employees, officers, directors, successors and assigns.

Parents/Guardians: If transportation is by private motor vehicle, parents mark appropriate lines below;

____ TRANSPORTATION PROVIDED BY CHARTERED BUS

____ TRANSPORTATION PROVIDED BY PRIVATE CAR

____ TRANSPORTATION PROVIDED BY SCHOOL VAN

____ MY CHILD MAY RIDE WITH AN ACADEMY STUDENT DRIVER

____ MY CHILD MAY NOT RIDE WITH AN ACADEMY STUDENT DRIVER.

______

Date Signature of Parent/Guardian

Parent/Guardian Cell #______

Phone numbers where Parent/Guardian may be reached during activities:

I understand that the Activities are made available through my enrollment as a student of Grebel Dance and that the regulations in the Grebel Dance student rules apply to my behavior. I understand and acknowledge that my violation of such regulations are likely to be cause for my immediate dismissal.

______

Date/ Signature of Student

Stevan Grebel Center for Dance Emergency Information and Medical Treatment Form

(please type or print )

Student’s Name ______Age ______

Address ______Home Phone ______

Parent (1) Name ______Work Phone ______

Relationship ______

Parent (2) Name ______Work Phone ______

Relationship ______

Please list any other numbers we may reach you at (i.e., pager, car phone, cellular phone):

( )______( )______( )______