Summer Student ResourcesPre-Check InStudent ResourcesOverviewPRE-CHECK INPROGRAM ORIENTATIONMASKS/VAXSCHEDULESQUESTIONSJOFFREY BALLET SCHOOL | SUMMER 2023Pre-Check In "*" indicates required fields 1Dancer Info2Parent/Guardian + Emergency Information3Intensive Information4Medical/Health History & Clearance Information5Sign & Submit Dancer Pre-Check InYou will only need to Pre-Check in once! If your dancer is attending more than one intensive: • Housing students attending more than 1 program may complete 1 check-in for all intensives. • Commuter dancers attending more than 1 program may complete 1 check-in for all intensives. • Students attending more than 1 program who are using Joffrey housing AND commuting may complete 1 check-in (please complete the housing check-in information) Before you begin, please have the following information ready for upload; For all dancers: • Insurance Information (if applicable) • Medication Information • Doctors note of clearance to attend: (Please provide a copy of a doctor’s note giving health clearance for your dancer’s attendance. In the body of the letter, simply have the doctor state that the dancer is healthy to participate in the summer program. Please note, a health physical of your dancer from the doctor’s office is not necessary.) Please click here for sample doctors note Pre-Check In should be completed by: • Housing Students: 1 week (7 days) before your arrival • Commuter Students: 1 week (7 days) before your arrival Pre-Check In Submission InfoYou will receive a copy of your completed questionnaire and documents via email. If you would like to update your information after submission, please email us at [email protected]. Dancer InfoDancer Name* First Last Dancer Email* Parent Email* Dancer Phone Number*Dancer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Dancer Date of Birth*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Dancer Age by June 1st, 2023*Please select dancer age2345678910111213141516171819202122232425What is your sex?* Female Male What is your Gender Indentity?* Female Male Non-Binary Prefer Not to Say Dancer Language of Preference*EnglishSpanishItalianJapaneseDancer Leotard/Dancewear Size* Youth Small Youth Medium Youth Large Youth Extra Large Adult Extra Small Adult Small Adult Medium Adult Large Adult Extra Large Sizing will be used for costuming for those dancer's who will be attending a performance week during their intensive. Parent InfoParent/Guardian Info*Dancer is in the custodial care of: Both Parents Mother Only Father Only Other Parent/Guardian 1 Name* First Last Parent/Guardian 1: Email* Must be different than dancer emailParent/Guardian 1: Phone*Parent/Guardian 2: Name* First Last Parent/Guardian 2: Email* Must be different than dancer emailParent/Guardian 2: Phone*Emergency Contact Info Same as parent info Emergency Contact #1* First Last Emergency Contact #1 Phone*Emergency Contact #1 Relationship* Emergency Contact #2* First Last Emergency Contact #2 Phone*Emergency Contact #2 Relationship* Intensive InfoSelect dancer intensive(s)*Please select all registered intensive Joffrey Cirque Arts Las Vegas Joffrey Colorado Joffrey Dallas Joffrey Italy Joffrey Las Vegas Joffrey Mexico Joffrey Miami (Ballet) Joffrey Miami (Jazz & Contemporary) Joffrey San Francisco Joffrey South (Ballet) Joffrey South (Jazz & Contemporary) Joffrey West JoffreyRED (Contemporary Ballet) NYC Ballet Intensive NYC Children’s Dance Camp (3 - 4) NYC Children’s Dance Camp (5 - 7) NYC Hip Hop Intensive NYC Jazz & Contemporary Intensive NYC Musical Theater Intensive NYC Pre-Professional Ballet Intensive NYC Pre-Professional Jazz & Contemporary Intensive NYC Tap Intensive Please select if you are a:* Housing Student Commuter Student Did you purchase a Meal Plan* Yes No Any dietary modifications (vegetarian/vegan/lactose free, etc)?* Yes No Explain any dietary modifications (vegetarian/vegan/lactose free, etc):* COVID-19For Summer 2023 COVID-19 Vaccination is NOT required to attend any Joffrey Ballet School Intensive. Masks are optional at ALL programs. Have you been vaccinated for COVID -19 ?* Yes No If Yes, please upload your immunization card below*Accepted file types: jpg, png, pdf, doc, Max. file size: 4 MB.COVID-19 TestCOVID-19 Tests are not required to attend the program.Health History and InformationHighly recommended vaccines to discuss with doctor before attending: - MMR (Measles, Mumps, Rubella) - DTap or Tdap (Diptheria, Tetanus, Acellular Pertussis) - MCV4/Menactra/Menveo (Meningococcal Disease/Meningitis) - Hepatitis A & B Vaccinations Vaccines recommended to consider/discuss with healthcare provider based on age: - Varicella/Chickenpox Vaccine - Gardasil (Human Papillomavirus HPV Vaccine) - PPV/Influenza (Pneumococcal Polysaccharide Vaccine) - IPV (Inactivated Polio Vaccine)Are all immunizations current?* Yes No If No, please state reason(s):* Tetanus Date:OptionalMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Any allergies?* Yes No Allergies*Please make sure to answer Yes/No to each "Allergy"YesNoInsect StingsPlants/TreesFoodMedicationsOtherPlease specify allergies*Explain “yes” answers. Include the type of allergy. (e.g. - “nut allergy” in the food category) Do any of the following apply to your child?* Specific needs or accommodations required Behavior and/or emotional problems Psychiatric counseling or hospitalization Operations or serious injuries History and/or treatment of eating and feeding disorders None of the above Prefer Not To Say Specific needs or accommodations:*Please explain in detailHistory and/or treatment of eating and feeding disorders*Please explain in detailBehavior and/or emotional problems:*Please explain in detailExplain any psychiatric counseling, self-harm history, or hospitalization:*Please explain in detailOperations or serious injuries:*Please explain in detailAre any prescription medications being taken?* Yes No How many prescription medication is being taken?*n/a123More then 3If your dancer takes more then 3 prescription medications please send a complete list to [email protected]. List the following information: Name of Medication, Reason for Medication, Dosage & FrequencyName of Medication #1* Reason for Medication #1* Dosage #1* Frequency #1* Name of Medication #2* Reason for Medication #2* Dosage #2* Frequency #2* Name of Medication #3* Reason for Medication #3* Dosage #3* Frequency #3* Are any of the following used?* EpiPen Inhaler N/A Insurance InformationDo you have Insurance? Yes No Insurance Company* Policy Number* Policy Holder* Insurance Providers Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Insurance Provider's Phone Number*Primary Care InformationOptionalWould you like to input this information today? Yes No Primary Care Doctor Primary Care Doctor PhonePrimary Care Doctor Email Please enter a valid email, if you don't have it please leave the field blankHealth & Medical AuthorizationI 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 6th and ending on August 28th unless sooner terminated in writing.* I agree Medical Clearance FormI/We hereby authorize and acknowledge the following:* My child is in good mental and physical health to participate in the summer intensive(s) Upload doctors note of clearance to attend:*(Mandatory for All Students) Please ensure your documents are less than 1MB. If it is bigger than 1MB, Please click here and resize your document:https://smallpdf.com/pdf-converter Please click here to see an attachment of a sample doctor’s note.Accepted file types: jpg, png, pdf, doc, Max. file size: 4 MB. Signatures & SubmissionSignatures Required • Health and Medical Authorization Forms • Waivers & Policies Forms I understand that I will be redirected upon submission to sign the above forms and will need to complete all required signatures. Dancer Electronic Signature*Parent/Guardian Electronic Signature*Unique IDToday's Date* MM slash DD slash YYYY CAPTCHA Housing OverviewHousing DetailsDownload TheHousing FAQQuestions?Customer Support [email protected] 888.438.3808Housing[email protected]
