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Marin Ballet Enrollment for Summer 2024

Student Information

First Name

Last Name

Gender

FemaleMaleNon-binary/non-conformingOther

Date of Birth

Age

Current School

Grade

as of the 2023-2024 school year

New to Marin Ballet?

YesNo

New to Marin Ballet

How did you first hear about us?

Previous Ballet/Dance School

Student Placement

Placement Requirement

Students who are new to Marin Ballet and registering for a Level 1 class or above are required to complete a skills review ("placement").

To arrange a placement, please contact:
Marin Ballet
100 Elm Street
San Rafael, CA 94901

info@marinballet.org

(415) 453-6705

Tuition and Fees

Tuition: $

Registration Fee: $

Performance Fee: $

Summer Program Total: $

Admin Fields - Student #1

Summer Program Weeks

Pre-Ballet/CM/Primary Weeks

BP/CM/Primary Weeks

Level 3/4 Weeks

Level 5/6 Weeks

Level 7/8/9 Weeks

Start Week

Session Weeks (#)

Billing Weeks (#)

Tuition/Week: $

Summer Tuition: $

Register a second Student?

YesNo

Student #2 Placement Level

Student #2 Placement Requirement

Students who are new to Marin Ballet and registering for a Level 1 class or above are required to complete a skills review ("placement").

To arrange a placement, please contact:
Marin Ballet
100 Elm Street
San Rafael, CA 94901

info@marinballet.org

(415) 453-6705

Student #2 Tuition and Payment

Tuition and Fees

Tuition: $

Registration Fee: $

Performance Fee: $

Summer Program Total: $

Admin Fields - Student #2

Summer Program Weeks #2

Pre-Ballet/CM/Primary Weeks

BP/CM/Primary Weeks

Level 3/4 Weeks

Level 5/6 Weeks

Level 7/8/9 Weeks

Start Week 2

Session Weeks 2 (#)

Billing Weeks 2 (#)

Tuition/Week: $ 2

Summer Tuition 2: $

Payment

Student Tuition & Fees

Student #2 Tuition & Fees

Multi-Student Discount: $

10% of the lower student tuition

Discount applied to:

Admin Code

Scholarship Calculations

Supported codes: MBFA## where ## = 10, 20, 30, 40, 50, 70, 90

Displayed as 0.80 = 20% discount, 1 = 100% (no discount).

Discount (%)

Discount: $

FORM TESTING: STRIPE TEST MODE

When Stripe Test Mode is ON, the Test Amount replaces the Summary Total Due amount. For example, if Summary Total Due is several thousand dollars, you can avoid running that amount through Stripe by enabling Test Mode and entering a smaller amount. The Test Amount will be processed and charged to the credit card.

If Stripe Test Mode is OFF, the full Summary Total Due amount will be factored into the Payment Due Now amount and that will be processed and charged through Stripe.

To test the form without a credit card charge, select Cash or Check.

Stripe Test Mode

OnOff

Test Amount ($)

Summary Total Due

Payment Options

Pay in Full nowPay Registration Fee now ($40) + Balance Due on July 2nd

Payment Due Now: $

Payment Method

Credit CardCheckCash

Credit Card Payment

Cardholder Full Name

Cardholder Email

Credit Card Number

Cardholder Zip Code

Exp. Month (##)

Exp. Year (##)

CVV (###)

Cash/Check Payment

Manual payments can be made by cash or check from August-April.
Please make your check out to: Marin Ballet and send to:

Marin Ballet
100 Elm Street
San Rafael, CA 94901

You may also make an in-person cash payment at this address.

Class ID

Prorated Price

Price

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Primary Parent/Guardian FOR MAILING and BILLING

First Name

Last Name

Relationship to Student

Parent/Guardian Email

Parent/Guardian Home/Cell Phone

Parent/Guardian Alternate Phone

MAILING Address

Parent/Guardian Street

Parent/Guardian City

Parent/Guardian State (XX)

Parent/Guardian Zip Code

Parent/Guardian Country

Parent/Guardian Employer

Parent/Guardian Position

Parent/Guardian Work Phone

Add a Parent/Guardian

YesNo

Parent/Guardian

Parent/Guardian #2 First Name

Parent/Guardian #2 Last Name

Relationship to Student

Parent/Guardian #2 Email

DO NOT ENTER A STUDENT OR OTHER PARENT EMAIL.
Enter a unique email for this parent or leave blank.

Parent/Guardian #2 Home/Cell Phone

DO NOT ENTER A STUDENT OR OTHER PARENT PHONE.
Enter a unique number for this parent or leave blank.

Parent/Guardian #2 Other Phone

Same MAILING Address?

YesNo

Parent/Guardian #2 Address

Parent/Guardian #2 Street

Parent/Guardian #2 City

Parent/Guardian #2 State (XX)

Parent/Guardian #2 Zip Code

Parent/Guardian #2 Country

Parent/Guardian Employer

Parent/Guardian #2 Employer

Parent/Guardian #2 Position

Parent/Guardian #2 Work Phone

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In case of emergency or disaster all efforts will be made to contact the parents at the phone numbers provided on the registration form. Please also provide alternative phone numbers and contacts.

Local Emergency Contact 1

Local Emergency Contact Name 1

Local Emergency Contact Phone 1

Local Emergency Contact 2

Local Emergency Contact Name 2

Local Emergency Contact Phone 2

Out-of-Area Emergency Contact

Out-of-Area Emergency Contact Name

(in case of local disaster)

Out-of-Area Emergency Contact Phone

(in case of local disaster)

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Marin Ballet is interested in sharing information about performances and school events with the grandparents of our students. Please provide information below so that your child’s grandparents can receive selected school mailings. Marin Ballet does not share personal information with other organizations.

Would you like to add grandparent(s)?

YesNo

Grandparents #1

Grandparent First Name(s)

OK to include two first names in this field.

Grandparent Last Name

Grandparent Email

Address of Grandparent to receive emails from Marin Ballet

Grandparent Address

Grandparent City

Grandparent State (XX)

Grandparent Zip Code

Would you like to add a second set of grandparent(s)?

YesNo

Grandparents #2

Grandparent First Name(s)

OK to include two first names in this field.

Grandparent Last Name

Grandparent Email

Address of Grandparent to receive emails from Marin Ballet

Grandparent Address

Grandparent City

Grandparent State (XX)

Grandparent Zip Code

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Marin Ballet Directory

Check here if you DO NOT wish to have your contact information published in the MB Directory (distributed to MB families only).

DO NOT LIST

Photo/Video Release

I release any claims on photos or videos taken of my child/ward while participating at any Marin Ballet event, performance, class, etc., and agree that Marin Ballet has permission to use these photos for its own promotional purposes.

Marin Ballet: Refund Policy

I have read and acknowledge Marin Ballet’s withdrawal, refund, and payment policies. I understand that I will be responsible for any balance owed to Marin Ballet if my child withdraws from the program at any time during the year. I also understand that I must inform the Registrar of my intent to withdraw my child. I understand I will be responsible for any assessed late fees in the event that my student’s quarterly tuition payment is not received by the due date listed in the registration paperwork.

Marin Ballet Medical Authorization

I hereby give Marin Ballet or its designated representative permission to obtain emergency medical attention, short of major surgery for my child/ward.

Marin Ballet COVID-19 Policy

Marin Ballet complies with the recommended preventive and containment policy for Covid-19. Parents are required to keep students exhibiting respiratory illness at home. Students testing positive for Covid-19 are required to stay home from ballet class until a negative test is received. Students exposed to Covid-19, but testing negative, may return to class wearing a mask until 5 days have passed, at which time a mask is no longer required. Parents recognize that Covid-19 is highly contagious and may be transmitted at ballet class. Parents agree to hold Marin Ballet harmless for any risk of their student’s infection at Marin Ballet.

Marin Ballet Injury Waiver

I understand that dancing is a strenuous exercise and that there is risk of injury in the execution of dance. My child/ward is in good and normal physical condition, and I will notify Marin Ballet about changes in her/his fitness. I will not hold Marin Ballet responsible for any injuries resulting from dance training.

I also understand that dance instruction involves kinetic corrections that may include physically touching the student as part of regular class work and rehearsals.

By submitting this registration form, you are agreeing to all of the Marin Ballet's policies and waiver agreements as described above.

Processing your enrollment may a couple of seconds.
PLEASE CLICK SUBMIT ONLY ONCE. CLICKING MORE
THAN ONCE MAY RESULT IN MULTIPLE CREDIT CARD
CHARGES.

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Marin Ballet Enrollment for Summer 2024

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