Dancer Information
Parent/Guardian Information (if Dancer is under 18)
Emergency Contact
Parent/Guardian will be first person notified; please provide alternate emergency contact.

Ekklesia Contemporary Ballet Release Information

Please initial each segment of this consent form. By doing so you will acknowledge that you have read and understand the terms outlined below. Parent/Guardian must initial if student is under 18.
Consent is granted for the student/performer to be photographed or videotaped. This may be used without compensation in a public presentation.
It is understood that the risk of physical injury is inherent in dance training. Ekklesia Contemporary Ballet strives to reduce that risk through proper training techniques. However, by signing this form, the undersigned is willing to assume those risks and release, hold harmless and indemnify Ekklesia Contemporary Ballet, its related entities (i.e. The Living Rock Church), agents, employees, officers and representative from and against any and all claims, demands, actions, judgments which the undersigned, or any other person ever had to may have against the Ekklesia Contemporary Ballet for any losses, costs and expenses (including Attorney’s fees) and damages or injuries known or unknown, real or personal, sustained by me or my shield while in attendance and /or participating in all Ekklesia Contemporary Ballet programs. The undersigned also agrees that he or she will not hold Ekklesia Contemporary Ballet responsible for the loss or damage of personal property while in attendance and/or participating in any of these programs. All minors must be covered by a personal health insurance policy.
Dance is an art form that requires teachers to be able to have appropriate physical contact for the purpose of making technical corrections. Consent is granted for such physical contact.
The signature below implies agreement to abide by the rules and policies of the Ekklesia Contemporary Ballet. This includes, but is not limited to, behavior that exhibits respect to fellow students, the teacher and the facility.


 Fee Schedule
Tuition $350
Room & Board $150
Registration $50
By submitting this form, I agree to abide by the refund/withdrawal policies described within the handbook or on the website. I also understand that I have read and agree to the Registrations and Tuition Fee Schedule for this fiscal year. Pricing is recorded on registration form and is subject to verification and correction. Parent or Guardian must sign this form if the student is a minor.