Adult Introduction to Ballet Enrollment ApplicationPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Student Information – Step 1 of 4Student InformationName *FirstLastSelect One: *New studentReturning studentDate of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920GenderOptionalHome Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *EmailConfirm EmailCell Phone *Additional InformationIs there any medical information about you that we should be aware of or that would be useful to your teachers? *If there are any conditions that will prevent your full participation in the program, please describe them here. *If there are any dates you will be absent or late, please list them here. *Would you be interested in volunteering with José Mateo Ballet Theatre?YesNoEmergency Contact InformationEmergency Contact Name *FirstLastRelationship *Cell Phone *NextDemographic SurveyDiversity and inclusion are at the core of José Mateo Ballet Theatre’s mission and commitment to the community. Gathering the information listed below allows us to improve the customer service that we give to all families. In addition, this information will further our diversity and inclusion efforts.This information will be kept anonymous and only be used to meet the needs of the families we serve.I am (select all that apply):WhiteBlackAsianHispanicPacific IslanderNativeOtherPlease specifyMy household income is:Less than $30,000$30,000-$60,000$60,000-$90,000$90,000-$120,000$120,000-$150,000$150,000-$200,000$200,000-$250,000Greater than $250,000The primary language spoken in my home is:What obstacles exist that prevent you from attending a José Mateo Ballet Theatre performance?Ticket CostNot InterestedChild CareLocation of TheatreNot enough timeNone, I attend JMBT performancesMy neighborhood is:(i.e., Winter Hill, Inman Square, Beacon Hill, Hyde Square, etc.)PreviousNextEnrollment AgreementI,Your Namein José Mateo Ballet Theatre’s 2024 Adult Introduction to Ballet Program.I understand that payment is due in full at the time of enrollment.I understand that, should I, for whatever reason, be unable to participate, withdraw from the program, be dismissed with cause, or be absent from the program, payments will not be refunded. Makeup classes are not given unless the student has a valid doctor’s notice for extended absence.I understand that upon enrollment into the program that mixing and matching different classes/levels and/or switching classes/levels is prohibited.I am aware that ballet training and the exercises associated with it can place stresses on the body and can risk physical injury. On behalf of the above named student and myself, I assume this risk and agree that José Mateo Ballet Theatre will not be liable in any way for injuries sustained during participation in the program or related activities.I grant José Mateo Ballet Theatre the right to make and use photographic and audiovisual documentation of me to be used for philanthropic, promotional, and other mission related purposes. (In no case will your identity be disclosed without written consent.)I understand that the primary method of communication from José Mateo Ballet Theatre is email through Constant Contact or Gmail in order to send announcements and other pertinent studio information.SignatureToday's Date *PreviousNextLevel & Class SelectionRe-enrollment in each class is recommended if the student feels that they are not ready to progress to the next level. However, students are encouraged to only enroll for a maximum of 3 sessions of each level before it is recommended they move up. Level Selection *Level ILevel IILevel I Class Time *Monday & Wednesday | 6:30-8:00PM with Betty Ann PlattTuesday & Thursday | 6:30-8:00PM with Genevieve BasuFriday | 10:30AM–12:00PM with Michael WagleyLevel I Session Dates *Fall I | September 9 – October 11Fall II | October 14 – November 15Winter I | November 18 – December 20^Winter II | January 6 – February 7Winter III | February 10 – March 14Spring I | March 17 – April 18Spring II | April 21 – May 23Fall Session I class is full!Fall Session II class is full!Level I Session Dates (Friday) *Fall | September 9 – November 15Winter | January 6 – March 14Spring | March 17 – May 23Level II Class Time *Monday & Wednesday | 6:30-8:00PM with Maria RoglerTuesday & Thursday | 6:30-8:00PM with Michael WagleyLevel II Session Dates *Fall I | September 9 – October 11Fall II | October 14 – November 15Winter I | November 18 – December 20^Winter II | January 6 – February 7Winter III | February 10 – March 14Spring I | March 17 – April 18Spring II | April 21 – May 23^ Makeup class for Thursday, November 28 (Thanksgiving) will be Friday, November 22TuitionTuition CodeTuitionPrice: $200.00Tuition (WSWS) *Price: $0.00Tuition (S100) *Price: $0.00Tuition (SSIII50) *Price: $100.00Tuition (FSII25) *Price: $175.00Tuition (Emily DeMazza)Price: $140.00Tuition (MTA10) *Price: $180.00Tuition (Yimei Gao) *Price: $0.00Total$0.00Payment InformationName on Card *FirstLastCredit Card Information *Card NumberMM123456789101112Expiration/YY2425262728293031323334Security CodeBilling Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSubmit