APLLICATION FOR: (Please mark all sessions if able to attend all sessions)
____ Session I - June 20 - July 10 / Intermediate--Pre-professional
____ Session II - July 11 - 31 / Intermediate--Pre-professional
____ Session III - August 1 - 21 / Advanced--Pre-professional
____ Session I & II - June 20 - July 10 / Intermediate--Pre-professional
____ Session II & III - July 11 - August 21 / Intermediate--Pre-professional
PLEASE PRINT ALL INFORMATION
Student_______________________________________________________________ Age _______ Birth date ___/___/___
*Email _______________________________________________________________ Sex _____ Height ____ Weight ______
*Please print your email address clearly to be notified of the results.
Mailing Address_______________________________________________________________________
City______________________________________________State__________Zip__________________
Day Telephone (_____)_____________________ Eve Telephone (_____)_________________________
Sex _____ Height ______ Weight _______ Email Address_________________________________
Are you are returning student to Extreme Ballet? Yes ___ No ___ Year ____ Session ____
Have you been accepted to previous Extreme Ballet programs but did not attend? Yes ____ Year _____
Total years of dance training: _____ Ballet class hours per week: ______ Pointe hours per week: ______
Jazz Dance Training? ______ Modern Dance Training? _______ Character Dance Training? ________
Current Ballet Studio __________________________________________________________________
Address __________________________________ City ___________________ State ____ Zip _______
Ballet teacher(s)_______________________________________________________________________
Have you attended other workshops/summer programs? ____ Which one/s? _______________________
___________________________________________________________________________________
Please complete the application form and return with the application fee and the required registration materials to:
Kaatsbaan, Timothy Hess, P.O. Box 482,
Tivoli, NY 12583
or by UPS or FedEx -
Kaatsbaan, Timothy Hess, 120 Broadway, Tivoli, NY 12583
Please charge application fee and/or tuition
of $_____________________ to my: Visa MC AMEX
Credit Card # ________________________________________________
Exp. Date ____/____ V-Code __ __ __ __(V-Code is the last 3 digits on back of
card of Visa & MC; 4 digits on AMEX)
Name (Please print) __________________________________ Day Phone (____)___________________
Billing Address for Credit Card ___________________________________________________________
Signature (Card Holder)________________________________________________________________