Commuter | Pre-Check In Forms and Authorizations

We are excited to bring you a great Summer. We have attached the following items below that are required to be signed.

Acknowledgement of Refund, Fees and Credit Card Policies
Waiver Agreements
Medical and Health Authorization Forms

Please do the following:

Please sign the items below
You will receive via email a completed packet once we verify all information

Dancer Name:

Dancer Summer Pre-Check In #:

Intensive(s):

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Center for American Dance (DBA Joffrey Ballet School). Refund, Fees and Credit Card Policies

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NON-REFUNDABLE TUITION AND OTHER FEES:

It is the policy of the Center for American Dance / Joffrey Ballet School that a student must state their intentions in writing to officially withdraw from a summer program and cancel their registration. This submission should be provided to support@joffreyballetschool.com. Registration fee and all processing fees are non-refundable and will be forfeited at the time of withdrawal. A student will receive a credit or a refund of all remaining fees paid up through the date of cancellation per the following policy. If the student is on a payment plan, any future payments due at the time of cancellation will be waived.

MEDICAL WITHDRAWAL:

If a dancer requests a medical withdrawal (due to injury or illness), depending on the date of notice, either a refund or a credit for any payments already made, less registration, processing fees and deposits (depending on the circumstances, see below) will be issued in the dancer’s name. Credits issued will be valid through August 31st of the next calendar year.

Notice received Prior to May 1st: Students may request a refund of the remaining fees paid to date after deducting the registration fee, processing fees, and deposits which are non-refundable. The registration fee and all processing fees are forfeited. Deposits will be placed in the student's account as a credit. The remaining amount will be refunded with the receipt of a signed doctor's note provided within 30 days of the withdrawal notice. Any future payments still due to the school will be waived at the time of withdrawal.
Notice received After May 1st: The registration fee, and all processing fees are forfeited and the balance will be applied to the student's account as a credit with the receipt of a signed doctor's note provided within 30 days of cancellation. Any future payments still due to the school will be waived at the time of cancellation.

NON-MEDICAL WITHDRAWAL:

For non-medical reasons, all payments made prior to withdrawal are non-refundable, however a credit for payments already made will be placed in the dancer’s name and valid through August 31st of the next calendar year. The amount of the credit will be determined by the date of withdrawal as follows:.

Prior to May 1st, the registration fee, and all processing fees are forfeited and the balance will be applied to the students account as a credit.
After May 1st, all deposits, in addition to registration and processing fees, are forfeited and the balance will be applied to the students account as a credit.

One week prior to a student’s program start date a student will receive a credit valid only until August 31st of the current summer. Credits will not be allowed to carry over to the following summer.

PROGRAM CANCELLATION:

In the event that a program is canceled, every effort will be made to reschedule. All payments will be applied to the rescheduled program. If a student does not wish to participate in the program on the rescheduled dates or if the program is not rescheduled, then the student will receive the option of a full credit of all monies paid or a refund less registration and processing fees. Credits are valid through August 31st of the next calendar year.

All credits are transferable. Refunds will be processed 8 weeks from the student’s original program start date.

PROCESSING FEE:

For all transactions, a 3.5% processing fee will be applied.

JOFFREY BALLET SCHOOL CREDIT CARD POLICY:

It is the policy of the Center for American Dance / Joffrey Ballet School that all students must retain a valid credit card on file at all times.

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Joffrey Ballet School Waiver Agreement

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I am not aware of any medical condition I have that should preclude me from participating in dance and / or aerial activities. I understand there is a definitive risk of injury associated with dancing and/or performing aerials, and that such injuries include, but are not limited to bruises, dislocations, broken bones, torn or damaged muscles and ligaments, paralysis, and even death. I understand that such injuries may be caused in whole or in party by myself, or by the actions or inactions of other students or instructors.

In consideration of being accepted for dance and or aerial instruction by the Center for American Dance (d.b.a. Joffrey Ballet School), and in further consideration of the expertise and achievements of instructors at the Center for American Dance (d.b.a. Joffrey Ballet School), and the limited number of students that may be accepted by the Center for American Dance (d.b.a. Joffrey Ballet School), I agree to all of the following, which shall bind me, and also my heirs, assign.

I understand and accept that dance education sometimes requires hands-on instruction as well as verbal instruction. I accept that instructors may correct dancers by touching their arms, legs, feet, hips, back and head to move them in the correct position. I further understand and accept that it is normal and usual for students to touch each other during dance class, including touching each other’s arms, legs, feet, hips, back and head, particularly, but not limited to, classes involving partnering and improvisation. I acknowledge and accept that this is a common standard in dance instruction and understand that it is the student’s responsibility to communicate clearly with the student’s teacher, other students, and/or the director if any form of touch is unacceptable to the student.

I/My child agree(s) to immediately stop performing any activity if I/they feel any pain, dizziness, light-headedness, or any other symptoms, and to immediately report those symptoms to the instructor. I/they also agree to carefully follow the instructors’ directions, to ask for additional directions if I do not understand any particular activity, and to immediately stop any activity which I/they believe I am/they are not competent or confident enough to perform.

To the fullest extent permitted by law, I/they agree and represent that I/they assume the risk and responsibility for any and all injuries to myself that I/they sustain while performing any dance or aerial activities, including any and all costs and damages that are a consequence of such injuries, and whether such injuries, costs and damages were caused in whole or in part by the Center for American Dance’s (d.b.a. Joffrey Ballet School) students, or instructors, or the Artistic/Program Director.

To the fullest extent permitted by law, I agree to defend, indemnify and hold harmless the Center for American Dance (d.b.a. Joffrey Ballet School), the Artistic/Program Director, and their instructors, agents, employees, contractors, clients, and students, from and against all claims, costs, damages, losses and expenses, including but not limited to attorney’s fees, arising out of or resulting from my performance or other participation in any dance or aerial activities, regardless of whether or not such claim, cost, damage, loss or expense, was caused in part by a party indemnified hereunder.

I am not aware of any medical condition I have or am suffering from that should preclude me from participating in dance activities. I understand there is a definitive risk of injury associated with dancing and that such injuries include, but are not limited to bruises, dislocations, broken bones, torn or damaged muscles and ligaments, paralysis, and even death. I understand that such injuries may be caused in whole or in partly by myself, or by the actions or inactions of other students or instructors. I also agree to carefully follow the instructors’ directions, to ask for additional directions if I do not understand any particular activity, and to immediately stop any activity which I believe I am not competent or confident enough to perform.

I understand that Center for American Dance (d.b.a Joffrey Ballet School) is not responsible for myself/my child if I/they leave the studio on lunch breaks on my/their own without school supervision.

I understand that in connection with the COVID-19 pandemic, Center for American Dance Inc. d/b/a Joffrey Ballet School is requiring all individuals who enter onto Joffrey premises, take a class at a Joffrey location or via remote learning, or otherwise participate in any Joffrey event to execute this Waiver and Release of Liability, acknowledging the risks related to COVID-19 as well as such other injuries that may result from such activities.

The waiver, release and other representations and covenants set forth herein are given in consideration for Joffrey permitting me and/or my child or ward to enter onto Joffrey premises, take a class at a Joffrey location or via remote learning, or otherwise participate in any Joffrey event.

Acceptance of Risk; Release; Indemnification. I am fully aware that there are a number of risks associated with me and/or my child or ward entering onto Joffrey premises, taking a class at a Joffrey location or via remote learning, and/or participating in any Joffrey event during the COVID-19 pandemic or at any time, including without limitation: (a) I and/or my child or ward and/or our family and/or other third parties with whom we may come into contact could contract COVID-19 or other diseases (including but not limited to influenza or legionnaires disease), which could result in a serious medical condition and/or require medical treatment in a hospital, and which may result in permanent harm and/or possibly lead to death; and (b) I and/or my child or ward will be subject to normal risks associated with engaging in physical activity such as physical injuries, including without limitation, from slips or falls, muscle pulls, broken bones, or such other serious injury, or loss or damage to personal property, or even death. On behalf of myself and/or my child or ward and our heirs, successors and assigns, I knowingly and freely, assume all such risks, both known and unknown (including but not limited to contracting COVID-19), relating to my and/or my child’s or ward’s entering onto Joffrey premises, taking a class at a Joffrey location or via remote learning, and/or participating in any Joffrey event, and I hereby now and forever release, waive, relinquish, and discharge Joffrey, along with their officers, directors, shareholders/owners, managers, officials, trustees, agents, employees, Greenwich Village Ballet LLC and the employees of Greenwich Village Ballet LLC, or other representatives, and their successors and assigns (collectively, the “Joffrey Parties”), from any and all claims, demands, liabilities, rights, damages, expenses, and causes of action of whatever kind or nature, and other losses of any kind, whether known or unknown, foreseen or unforeseen, (collectively, “Damages”) as a result of me and/or my child or ward entering onto Joffrey premises, taking a class at a Joffrey location or via remote learning, and/or participating in any Joffrey event, including but not limited to those related to the above described personal injuries, death, disease or property losses, or any other loss, and including but not limited to claims based on the alleged negligence of any of the Joffrey Parties or any other person. I further promise not to sue or Joffrey or any of the Joffrey Parties, and agree to indemnify and hold them harmless from any and all Damages resulting from my and/or my child’s or ward’s entering onto Joffrey premises, taking a class at a Joffrey location or via remote learning, and/or participating in any Joffrey event. I understand that my agreement herein is on-going and continuous and shall not need to be renewed, but Joffrey may request my updated signature at any time.

I further agree and request for myself and/or my minor children that our relevant health information regarding personal health information, care and treatment be released for the limited purpose of contact tracing related to the novel coronavirus COVID-19 pandemic. In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), I understand that: (1) The information disclosed shall be limited only to information relevant to the COVID-19 pandemic and for the purpose of contact tracing; (2) This authorization shall NOT include disclosure of information relating to alcohol and drug abuse, mental health treatment, or confidential HIV related information. If this information is disclosed, I understand that I have the right to request a list of people who may receive or use the disclosed information without authorization; if I experience discrimination because of the release or disclosure of such information, I may contact the New York State Division of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450, which are the agencies responsible for protecting my rights; (3) I have the right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke this authorization except to the extent that action has already been taken based on this authorization; (4) I understand that signing this authorization is voluntary and health care treatment, payment of health care charges, enrollment in a health plan, or eligibility for health care benefits will not be conditioned upon my authorization of this disclosure; (5) Information disclosed under this authorization might be redisclosed by the recipient, and this redisclosure may no longer be protected by federal or state law; (6) THIS AUTHORIZATION DOES NOT AUTHORIZE DISCLOSURE OF HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN CONTACT TRACERS AND ONLY TO THE LIMITED EXTENT NEEDED FOR SUCH PURPOSE

I understand that should I be diagnosed with COVID-19 within 10 days of the start of my intensive, I must immediately notify the Joffrey Ballet School to determine if I can attend the program. If I have attended the intensive in the past 3 days I must notify the Joffrey program. I understand that , in accordance with the refund policy of the Center for American Dance (d.b.a. Joffrey Ballet School), I may not be eligible for a refund.

I have fully read and agree to all of the above, and I make this agreement and the representations herein in order to induce the Center for American Dance (d.b.a. Joffrey Ballet School), to allow me to audition to be a student for dance instruction.

In the event that the participant/student is a minor or is not of such capacity to be held legally responsible for executing this agreement, the undersigned parent and/or legal guardian signs this on behalf of the participant/student and individually. If, despite this release, the participant makes a claim against any of the Releases, the parent(s) and/or legal guardian(s) will reimburse the Releasee for any money which they have paid to the participant, or on their behalf, and hold them harmless.

I have fully read and agree to all of the above, and I make this agreement and the representations herein in order to induce the Center for American Dance (d.b.a. Joffrey Ballet School), the Artistic/Program Director, to accept me as a student for dance and/or aerial instruction.

I agree and understand the above. I have fully read and agree to all of the above, and I make this agreement and the representations herein in order to induce the Center for American Dance (d.b.a. Joffrey Ballet School), the Artistic/Program Director, to accept me as a student for dance and/or aerial instruction.

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Limited Use Photographic & Video Release

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For and in consideration of my engagement as a student and / or model by the Joffrey Ballet School – Center for American Dance (hereafter referred to as the School) and photographer and/or videographers contracted by the Joffrey Ballet School (hereafter referred to as the Photographer/Videographer), on terms hereinafter stated, I hereby give the Photographer/Videographer and the School, their legal representatives and assigns, those for whom the Photographer/Videographer and School are acting, and those acting with their permission, the right to copyright and / or use, reuse and / or publish, and republish the photographic pictures and/or video of me taken during the course of my study at the School or at any School performances.

I hereby waive any right to inspect or approve the finished photograph(s) and/or videos prior to publication.

I hereby release, discharge and agree to save harmless the Photographer/Videographer and the School, their representatives, assigns, or any other person or persons, corporation or corporations, for whom they might be acting, including any firm publishing or producing and / or distributing the finished product, in whole or in part, from and against any liability as a result of it’s publication or distribution of the same.

I certify that I, suffering under no legal disabilities and that I have read the foregoing release, authorization and agreement, before affixing my signature below, and warrant that I fully understand the contents thereof.

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Parental Authorization

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The Center for American Dance / Joffrey Ballet School is not liable or responsible for the negligence or for the acts of others. Students, parents/legal guardians of minor students and any other person or entity covered by this Agreement hereby agrees that The Center for American Dance / Joffrey Ballet School should not be liable for the act of any other person, including but not limited to any roommate, invitee, friend or neighbor of the dormitory residents or The Center for American Dance / Joffrey Ballet School staff or resident advisor. Student, parents of minor students and/or legal guardian, as well as any other person or entity signing this Agreement, agrees that The Center for American Dance / Joffrey Ballet School shall not, and cannot, be held liable for any negligence or acts of these others, including but not limited to any negligence in the placement of the student with a particular host or residence or roommate.

This Agreement shall be interpreted in accordance with the Laws of the State of New York. The Student/parents/guardians of a minor student, or any other entity or person signing this Agreement, hereby agrees to submit to the personal jurisdiction of the State of New York Center for American Dance / Joffrey Ballet School. Any litigation between the parties to this Agreement, for any reason or cause, including the alleged breach of this Agreement or otherwise, shall only be brought in the Supreme Court State of New York, New York County.

Parent Initial:

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Absences

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If a student will be late or absent, they should use BAND to communicate this to the staff on-site. If you are experiencing issues with BAND, you may also communicate tardiness or absences to the Administrative Assistants.

Please include the following information in your message:

Name of the intensive your student is enrolled in
Dancer's full name (first, last)
Dancer's current Group assignment
Date of tardiness or absence
Specific details regarding your dancer (any classes the student will miss ie: morning/afternoon/entire day)
Parent name (first, last) and contact information (in the event that we need to reach out to you)

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Entering & Leaving the Studios

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Dancers 13 and younger and their guardians understand that Joffrey Ballet School staff will not be responsible for escorting commuter students to and from assigned studio locations. Parents and guardians should arrange for students to arrive on-time for the designated start time and promptly at the end of each day. Dancers 13 and younger will not be allowed to leave the studios on designated breaks, unless accompanied by a parent or guardian and communicated with the staff of Joffrey Ballet School. Traveling with another dancer outside of the studios on a break, no matter the accompanying dancer’s age, will not be permitted.

Dancers 14 and older and their guardians understand that dancers 14 years of age and older are able to leave the studios on designated breaks with fellow dancers 14 years of age and older without supervision. We encourage dancers to travel in pairs or groups whenever possible.

Dancers are encouraged to bring lunch, snacks, and water every day, as breaks are short and do not allow much time to leave the studios. In New York City Commuter dancers can register for the optional studio lunch plan, catered by Panera, will be delivered to the studio Monday - Friday.

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Summer Program Agreement

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I understand that if any of the rules and regulations of the program are broken by the student, the Artistic Director reserves the right to dismiss the student and send them home without refund or recourse. I, THE STUDENT, agree to abide by all rules and regulations set in place by Joffrey staff. I understand that the Joffrey Ballet School is not liable for stolen or damaged personal items while studying in the program. I understand that I am liable for all fee's associated with the program and by signing this form I am registering for the program and agree to pay the program costs in full. I understand that deposit fee's are due upon registration, and the balance of all other fees are due on June 1st.

Dancer Signature :

Dancer Name:

Dancer Email:

Parent/Guardian Signature :

Date:

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Emergency Contact Information & Health History and Medical Authorization Form

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Date:

DANCER INFO

Dancer Name:

Address:

Dancer Date Of Birth:

Dancer Age:

Dancer Sex:

Dancer Identity:

PARENT INFO

Parent/Guardian Name #1:

Parent/Guardian Phone #1:

Parent/Guardian Email #1:

Parent/Guardian Name #2:

Parent/Guardian Phone #2:

Parent/Guardian Email #2:

EMERGENCY CONTACT INFO

Emergency Contact #1:

Emergency Contact #1 Cell Phone:

Emergency Contact #1 Relationship:

Emergency Contact #2:

Emergency Contact #2 Cell Phone:

Emergency Contact #2 Relationship:

ALLERGIES INFO

Do any of the following apply to your child? (Specific needs or accommodations required, Behavior and/or Mental Health history, Psychiatric counseling or hospitalization, Operations or serious injuries)

Are any of the following used (EpiPen, Inhaler)?

Explain any dietary modifications (vegetarian/vegan/lactose free, etc):

IMMUNIZATION HISTORY

Are all immunizations current?

If not, state reason(s):

Tetanus Date:

INSURANCE INFORMATION

Insurance Carrier:

Insurance ID:

Primary Holder:

Carrier Phone #:

Carrier Address:

PRIMARY CARE INFORMATION:

Primary Care Doctor:

Primary Care Doctor Phone:

Primary Care Doctor Email:

Primary Care Doctor Address:

HEALTH & MEDICAL AUTHORIZATION

When filling out the Health Form, the “Agent” is Joffrey Ballet School, Center for American Dance, Inc.

I certify that all of the above is true and accurate. I understand that if I have provided false, misleading, or incomplete information the student may be immediately removed from the dormitory without refund of any fees. This health history is correct so far as I know. I/We, the undersigned, parents/legal guardians of (the “Minor”), a minor, do hereby authorize (the “Agent”), on behalf of the undersigned, to consent to the surgical, dental and/or medical examination or treatment of the Minor. Such treatment may include, but is not limited to, the following: transportation by ambulance, examination, xrays and other diagnostic procedures, any diagnoses, hospitalization, anesthesia, surgery, medication, and/or transfusion of blood or blood products. Agent may have access to any and all records, including, but not limited to, insurance records regarding any such services. t is understood that this Authorization is given in advance of any specific diagnosis, treatment, or hospital care being required, but is given to provide authority and power on the part of our aforesaid Agent to give specific consent to any and all such diagnoses, treatment, or hospital care which the physician or other caregiver may in the exercise of their best judgment may deem advisable.

This Authorization shall be effective beginning on June 3rd and ending on August 24th unless sooner terminated in writing

RELEASE AND INDEMNIFICATION:

I/We, the undersigned, parents/legal guardians of the Minor, shall indemnify, hold harmless, assume liability for, and defend the Agent, Joffrey Ballet School, Center for American Dance, Inc., their affiliated entities, its owners, directors, officers, employees, and agents from and against any and all liability for personal injury, damages, costs and/or expenses, including but not limited to attorney’s fees and costs, arising or resulting from the exercise of any powers granted under this Authorization.

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Completion of Pre-Check In Form

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Date:

Parent/Guardian Name, Email and Signature:

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Signed by Frank Lee Merwin
Signed On: April 1, 2024

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May 3, 2021 6:37 pm EST

Commuter | Pre-Check In Forms and Authorizations Uploaded by Frank Lee Merwin - support@joffreyballetschool.com IP 2603:8000:1b40:aa6b:2527:6e4e:f54f:c92c

May 6, 2021 2:46 pm EST

Joffrey Ballet School - kgejapch@mailparser.io added by Gail D'Addario - support@joffreyschool.com as a CC'd Recipient Ip: 172.119.197.59

May 27, 2021 9:59 am EST

Joffrey Ballet School - kgejapch@mailparser.io added by Gail D'Addario - support@joffreyschool.com as a CC'd Recipient Ip: 172.119.197.59

March 30, 2022 2:38 pm EST