August 15, 2006 Dear Prospective Dance Theatre of Harlem ...
August 15, 2006 Dear Prospective Dance Theatre of Harlem ... August 15, 2006 Dear Prospective Dance Theatre of Harlem ...
The Kennedy Center’s Dance Theatre of Harlem Pre-Professional Residency 2006-2007 APPLICATION FORM Please Type or Print Clearly Name ______________________________________Age ____ Birth Date _________ Sex___Height_____Weight______ Parent/Guardian _______________________________________________Phone (Daytime) ______________________ Address___________________________________________________________________________________________ (Street) (City) (State) (Zip) County___________________________________________ E-Mail __________________________________________ Ballet Training: Ballet classes: # of yrs. __________________ # of classes per week __________________________ Pointe classes: # of yrs. __________________ # of classes per week __________________________ Dance School ___________________________________ Address____________________________________________ Name of Dance Teacher(s) ____________________________________________________________________________ Have you studied other forms of dance? Yes___ No___ Form of dance ________________________________________ Name of Academic School ____________________________________________________________________________ City/State _________________________________________ Grade Point Average (most recent school year) _________ How did you first find out about this program? ___________________________________________________________ Previous participation in this program (Yr. & Phase, i.e., 98/99 - I & II, 99/00 – I & II etc.) _______________________ Please initial on the line beside the following items to indicate your understanding and commitment: ___I understand that the student must participate in the audition. I have reserved the full time period on my calendar pending receipt of the Confirmation Letter from the Kennedy Center. Auditions are September 30, 2006. ___I understand that if selected from the audition on September 30, 2006, the student is expected to attend all of the classes beginning on October 21, 2006 and a one-time fee of $125 is payable at the first class. ____I understand that the student is expected to attend class on time and to be properly dressed in order to actively participate in class. Complete both sides of the application and send to: The Kennedy Center Attn: Education Department ATTACH DTH Pre-Professional Residency WALLET PO Box 101510 Application Deadline: SIZE Arlington, VA 22210 September 15, 2006 PHOTO HERE Or FAX both sides of the completed application to (202) 416-8802. If faxed, the original application and photo must be received before or at the audition. Please retain the fax receipt until the Confirmation Notice is received from the Kennedy Center.
Student Waiver Form In order to participate in the Kennedy Center’s Dance Theatre of Harlem Pre-Professional Residency audition and subsequent classes, you must submit this waiver form signed by the parent/guardian of the applicant. GENERAL INFORMATION Student’s Name_____________________________________________________________ Date of Birth _____________________ Address____________________________________________________________________________________________________ (Street) (City) (State) (Zip) Mother/Guardian _____________________________________________________ Phone: Daytime__________________________ Evening _________________________ Father/Guardian ______________________________________________________ Phone: Daytime _________________________ Evening _________________________ MEDICAL INFORMATION (If not completed, student will not be allowed to participate in the audition or subsequent classes.) Health Plan/Insurance Company ______________________________________ ID # ____________________________ Pertinent Medical Information (allergies, medications, etc.) _________________________________________________ EMERGENCY CONTACTS (Indicate priority number, e.g., 1,2,3. A minimum of two contacts is required) _____ Mother/Guardian _____ Father/Guardian _____ Other: _________________________________________________________ Phone: Daytime ________________________ (Name) Evening ________________________ Relationship to Student: ______________________________________ I/We, the undersigned, parent(s) and/or guardian(s) of the above-named student (the Child), hereby consent to the participation of the Child, as a volunteer, in the Kennedy Center’s Dance Theatre of Harlem Pre-Professional Residency (the “Event”) sponsored by the John F. Kennedy Center for the Performing Arts (the “Presenter”). I/We hereby irrevocably consent to and authorize the use and reproduction by the Presenter of any and all photographs, recordings, videotapes, and/or other reproductions or likenesses of the Child’s person or characteristics (“reproductions”) which have been secured by or for the Presenter, for any purpose whatsoever, without compensation to the Child. All reproductions shall constitute the property of the Presenter, solely and completely. Further, I/we assign and release all rights to said reproductions and authorize the Presenter, or others authorized by it, to exhibit, broadcast, and/or distribute or otherwise further reproduce said reproductions in whole or in part over or in any medium whatsoever, including, without implied limitation, newsletters, radio, newspapers, closed circuit television, film, cable, and television, with or without compensation, in perpetuity. I/We also release, discharge, and agree to hold harmless the producers or any persons, or entities acting under their permission or authority, from any liability arising from the use of said reproductions. I/We acknowledge and agree that I/we will be responsible for transporting the Child to and from all Event sites to participate in the Event. I/We further discharge and release the Kennedy Center and its trustees, officers, and employees from any and all liability for injury, loss, damage, obligation, expense, or penalty sustained by the Child arising out of or in connection with the Child’s participation in the Event. In the event that any serious injury shall occur involving the Child, I wish for the Kennedy Center supervisory personnel to take appropriate steps to immediately notify the emergency contact specified above, but if all emergency contacts are inaccessible for any reason, I authorize whatever medical attention is deemed appropriate for the child. ______________________________________________________________ Signature (Parent/Guardian) ________________________________ Date
- Page 1 and 2: THE JOHN F. KENNEDY CENTER FOR THE
- Page 3: 3. Commit to the Program Requiremen
The Kennedy Center’s <strong>Dance</strong> <strong>Theatre</strong> <strong>of</strong> <strong>Harlem</strong> Pre-Pr<strong>of</strong>essional Residency<br />
<strong>2006</strong>-2007 APPLICATION FORM<br />
Please Type or Print Clearly<br />
Name ______________________________________Age ____ Birth Date _________ Sex___Height_____Weight______<br />
Parent/Guardian _______________________________________________Phone (Daytime) ______________________<br />
Address___________________________________________________________________________________________<br />
(Street) (City) (State) (Zip)<br />
County___________________________________________ E-Mail __________________________________________<br />
Ballet Training: Ballet classes: # <strong>of</strong> yrs. __________________ # <strong>of</strong> classes per week __________________________<br />
Pointe classes: # <strong>of</strong> yrs. __________________ # <strong>of</strong> classes per week __________________________<br />
<strong>Dance</strong> School ___________________________________ Address____________________________________________<br />
Name <strong>of</strong> <strong>Dance</strong> Teacher(s) ____________________________________________________________________________<br />
Have you studied other forms <strong>of</strong> dance? Yes___ No___ Form <strong>of</strong> dance ________________________________________<br />
Name <strong>of</strong> Academic School ____________________________________________________________________________<br />
City/State _________________________________________ Grade Point Average (most recent school year) _________<br />
How did you first find out about this program? ___________________________________________________________<br />
Previous participation in this program (Yr. & Phase, i.e., 98/99 - I & II, 99/00 – I & II etc.) _______________________<br />
Please initial on the line beside the following items to indicate your understanding and commitment:<br />
___I understand that the student must participate in the audition. I have reserved the full time period on my calendar<br />
pending receipt <strong>of</strong> the Confirmation Letter from the Kennedy Center. Auditions are September 30, <strong>2006</strong>.<br />
___I understand that if selected from the audition on September 30, <strong>2006</strong>, the student is expected to attend all <strong>of</strong> the classes<br />
beginning on October 21, <strong>2006</strong> and a one-time fee <strong>of</strong> $125 is payable at the first class.<br />
____I understand that the student is expected to attend class on time and to be properly dressed in order to actively<br />
participate in class.<br />
Complete both sides <strong>of</strong> the application and send to:<br />
The Kennedy Center<br />
Attn: Education Department<br />
ATTACH<br />
DTH Pre-Pr<strong>of</strong>essional Residency<br />
WALLET<br />
PO Box 10<strong>15</strong>10 Application Deadline: SIZE<br />
Arlington, VA 22210 September <strong>15</strong>, <strong>2006</strong> PHOTO<br />
HERE<br />
Or FAX both sides <strong>of</strong> the completed application to (202) 416-8802. If faxed, the<br />
original application and photo must be received before or at the audition. Please retain<br />
the fax receipt until the Confirmation Notice is received from the Kennedy Center.
Change language