Ketchikan Theatre Ballet Online Registration

Registration

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Welcome to Ketchikan Theatre Ballet! Please complete the following registration form.

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Contact #1

Contact #1 First Name*

Last Name *

How Can We Contact You?

Home Phone

Work #

Cell #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Disabilites

Allergies

Medications

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Disabilites

Allergies

Medications

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Disabilites

Allergies

Medications

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Disabilites

Allergies

Medications

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level*

Disabilites

Allergies

Medications

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Add Another Student

Required Policies and Agreements

Agreement

I have been given the KTB Cost and Participation Disclosure and have read and understood it. I understand and agree to abide by the policies and procedures outlined in the KTB Student Handbook and Policy Manual, including but not limited to class attendance, dress code, participation requirements, video taping policy, and the student code of conduct.

I understand that regardless of educational stipends, scholarships or any other financial supplement I am ultimately responsible for paying my student's tuition and any other costs in a timely manner each month.

I understand and agree to all requirements as presented in the KTB Cost and Participation Disclosure and outlined in the KTB Student Handbook and Policy Manual, financial as well as participatory, including but not limited to tuition payments, late fees, volunteering, and selling raffle tickets.

I acknowledge, understand and agree to specifications as set forth in this document and the KTB Student Handbook and Policy manual and to the program under which my student shall participate and accept the program together with the instructor and method of teaching that will be employed at KTB.

I've read the above and agree.

Raffle Policy

I understand that each family will be billed a $150 Fundraising Fee in November and again in April and that I will have the opportunity to sell raffle tickets to offset this cost.

I've read the above and agree.

Hold Harmless

In consideration for accepting this registration, I hereby for myself, my child, my heirs, executors, administrators and assigns, waive and release any and all rights and claims I or my child may have at any time against Ketchikan Theatre Ballet and its directors, representatives, employees, officials, successors and assigns (collectively Ketchikan Theatre Ballet) for any and all claims, injuries, including death, or damages suffered by my self or my child of whatsoever nature at any activity sponsored by, and any medical care approved by Ketchikan Theatre Ballet and agree to indemnify, defend and hold harmless KTB from any and all such claims, including claims for costs and attorneys fees.

I've read the above and agree.

Media

I do hereby give Ketchikan Theatre Ballet permission to use my child's name, portrait, video or photograph, including composite or distorted representations, for the purpose of publicizing or advertising Ketchikan Theatre Ballet. I waive any right to inspect or approve the finished product, including written copy that may be created in connection there within.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Account Information

Payment Schedule*

Type of payment*

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip