The Willis Ballet
Manager _________ Invoiced __________
Please Make Checks Payable to Willis Conservatory of Classical Ballet:
I acknowledge that I have read and agree with
the Willis Conservatory of Classical Ballet Waiver Form (see below).
Signature required for class
you for Choosing Willis Conservatory of Classical Ballet for your Dance Lessons!
Help us best serve the community by telling us how you heard about us.
Name_______________Yellow Pages _________
City of PC_________
_________ Friend Referral ________________ Specify Other ___________
understand and agree to the following:
Tuition for the Willis Conservatory of Classical Ballet (CCB) is due at
the beginning of each semester. Payment
is to be made to The Willis Conservatory of Classical Ballet and can be made in
one or ten payments.
The Registration fee is non-transferable and non-refundable.
The annual registration fee of $35.00 is required for all students.
No refunds will be issued for missed lessons. Make-ups are available for illness, injury, and or inclement
weather during other class times to be approved by the CCB Director or Manager.
Refund policy: CCB must
receive in writing, a request stating the reason for a refund at least thirty
days prior to withdrawal from the program and will be granted at the discretion
of the Director.
I agree_______, I do not agree ______
to have my childís photo and name to be posted on the Willis Balletís
website. If needed, I will ______,
or will not ______
provide the photo.
RELEASE: The undersigned
students, parent(s), or guardian of the student hereby release and waive any all
claims against The Peggy Willis Ballet Company (The Willis Ballet) or The Willis
Conservatory of Classical Ballet (CCB), its owners, director, manager, teachers,
and or teaching assistants for any liabilities for injuries, including personal
and bodily injury, to the person or persons related to students or the damage of
property of the property of the person or persons related to the student, which
may occur while participating at The Willis Ballet/CCB premises or at any
premise building in conjunction with an activity by The Willis Ballet, unless
said injuries or damage is caused by negligence of The Willis Ballet/CCB or any
of its employees. The undersigned
represents that the student is in good health and does not have any history of a
medical or physical condition (unless specified in the registration form) that
would place the student at risk because of his/her condition.
The undersigned further acknowledges that the studentís instruction
involves physical exercise and physical stress, which could result in physical
injury of the student,
I agree to the
Payment Play of ________ 1 payment ________ 10 payments
I acknowledge that
I have read and completed the enrollment form and agree with the Waiver
(Parent or Guardian
signature is required for Class Participation, unless student is over 18
years of age.)
(parent or guardianís signature if student is under 18 years of age)
/ / )