2026 Back to the Barre - Registration & Payment Form

Back to the Barre

August 10-14, 2026

for Level 3 and Up

Ages 11-18

Monday, 4:45-6:15pm – Ballet class

Tuesday, 4:45-6:15pm – Ballet class, 6:15-7:15pm - Pointe/Men's technique

Wednesday, 4:45-6:15pm – Ballet class

Thursday, 4:45-6:15pm Ballet class, 6:15-7:15pm Pilates

Friday, 4:45-6:15pm Ballet class, 6:15-7:15pm Pointe/Men's technique

Participants can choose to attend the entire week or a single class.

Full Week: $90.00

Single Class: $15.00
Student Name

First NameMiddle NameLast Name
Student Age
Student Birth Date

MonthDayYear
Primary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Contact Information
Parent E-mail
example@example.com
Parent/Guardian 1 Name

First NameLast Name
Emergency Contact Phone Number
Format: (000) 000-0000.
Please list any medical conditions or disabilities we should be aware of.
I give Florida Ballet permission to give the following to my student at their discretion, for acute pain not relieved by non-medical means.
Consent to Medical Treatment

In an emergency, when parental permission is not available, I hereby give my permission for a Florida Ballet staff member to consent to medical treatment for our child and/or ward.
In an emergency, when parental permission is not available, I hereby give my permission for a Florida Ballet staff member to consent to medical treatment for our child and/or ward.
Liability Waiver
I am aware that dance and the nature of the training and performing associated with The Florida Ballet place unusual stress on the body and carry with them the risk of physical injury. On behalf of my child and myself, I assume the risk and agree that Florida Ballet at Jacksonville, Inc., the Training Center and the staff of this institution shall not be liable in any way for injuries sustained during attendance in classes, rehearsals, or related functions.

It is also understood that dance instruction involves kinetic corrections that may include physically touching a student as part of regular class work and rehearsals. Parents or students with any concerns should speak with their instructors before class.
I certify that I have read and fully understand this liability waiver and that all questions pertaining to this consent have been answered to my satisfaction.
Photograph/Video Release Authorization
I, the undersigned, give permission to the Florida Ballet, and/or parties designated by The Florida Ballet to photograph/video me or the minor named below and use such photograph(s)/video(s) in all forms of media, for any and all promotional purposes including advertising, display, audiovisual, exhibition or editorial use.

I further consent to the use of my name or the minor’s name listed below in connection with the photograph(s)/video(s) if needed by The Florida Ballet and/or parties designated by The Florida Ballet.

I understand and agree that I or the minor listed below will not receive any payment for time, expenses or any royalty for the publication of the photograph(s)/video(s) or the use of my/minor’s name and I hereby release The Florida Ballet and/or any parties designated by The Florida Ballet from any such claims.
I certify that I have read and fully understand this consent and release, and that all questions pertaining to this consent have been answered to my satisfaction.
By signing below I, First Name Last Nameas the parent/legal guardian of minor,First Name Last Name , hereby consent that I have carefully read and fully understand all provisions of this release, and freely and knowingly assume the risk and waive my rights concerning liability as described above.
Date

MonthDayYear
Date
Parent Signature or Personal Signature if over 18

My Products

Entire Week

M-F (8 classes)

$90.00

Single Class: Monday, August 10

4:45-6:15 Ballet Class

$15.00

Single Class: Tuesday, August 11

4:45-6:15 Ballet Class

$15.00

Single Class: Tuesday, August 11

6:15-7:15 Pointe/Men's (must attend prior ballet class)

$15.00

Single Class: Wednesday, August 12

4:45-6:15 Ballet Class

$15.00

Single Class: Thursday, August 13

4:45-6:15 Ballet Class

$15.00

Single Class: Thursday, August 13

6:15-7:15 Pilates

$15.00

Single Class: Friday, August 14

4:45-6:15 Ballet Class

$15.00

Single Class: Friday, August 14

6:15-7:15 Pointe/Men's (must attend prior ballet class)

$15.00

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

Back to the Barre

Parent/Guardian Contact Information

Consent to Medical Treatment

Liability Waiver

Photograph/Video Release Authorization

My Products*

My Products