KAATSBAAN INTERNATIONAL DANCE CENTER
2008 EXTREME BALLET APLICATION FORM    

APPLICATION FOR:

____ EXTREME BALLET WINTER WORKSHOP   Friday, February 15-Monday, February 18  
____ EXTREME BALLET SUMMER INTENSIVE PROGRAM 
____ Session I - June 16-July 5   Intermediate--Pre-professional
____ Session II - July 6-26 Intermediate--Pre-professional  
____ Session III - July 27-August 16 Advanced--Pre-professional
____ Session I & II - June 16-July 26 Intermediate--Pre-professional
____ Session II & III - July 6-August 16 Intermediate--Pre-professional                                      

PLEASE PRINT ALL INFORMATION    

Student________________________________________________ Age _______ Birth date ___/___/___            
 

*Email _______________________________________________ Sex _____ Height ____ Weight ______
*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)

Name (Please print) __________________________________ Day Phone (____)___________________

Billing Address on Credit Card ___________________________________________________________

Signature____________________________________________________________________________