STUDENT INFORMATION
Student Name:
Birth Date:
Student Home Address:
Age:
Gender:
Student Email:
MOTHER/GUARDIAN INFORMATION
Mother's Name:
Mother's Home Phone (if different than student's):
Mother's Address (if different than student's):
Mother's Cell Phone:
Mother's Email:
FATHER/GUARDIAN INFORMATION
Father's Name:
Father's Home Phone (if different than student's):
MEDICAL INFORMATION
Insurance Company:
Policy Number:
Student's Physician:
Physician's Phone Number:
Allergies:
Recent Injuries:
DANCE TRAINING
School | Dates | Teachers | Classes per week
PREVIOUS BALLET SUMMER INTENSIVES
Summer Intensive | Level | Dates
How did you hear about the Irina & Max Summer Intensive?
Facebook
Instagram
Poster/Flyer
YAGP
Friend (Whom should we thank?)
Attended a Workshop at ABT
Other (please specify)
ENROLLMENT
Tuition:
You have the option to take 1, 2 or 3 weeks. You will have more benefits if you take all 3 weeks.
$875
for one week
$1,750
for two weeks
$2,625
for tree weeks
a NON REFUNDABLE $350 deposit will be applied towards tuition costs
2022 Enrollment Period:
Week 1: August 1 – August 5
Week 2: August 8 – August 12
Week 3: August 15 – August 19