Peter Pan Boy's Workshop September 18,2022

Please complete this form and submit your non-refundable, non-transferable payment to register for the Peter Pan Boy's Workshop. If you experience any issues, please email Katie Wesche at

Program Information

Please note that if you receive the notice stating, "Sorry! All seats are occupied for the applied course.", then the selected housing option is full. Please email Katie Wesche here to be placed on the waitlist.

Student Information

Please complete if different from Student's First Name.

Please enter date of birth as MM-DD-YYYY

This information is only used for data reporting purposes. You have the option to click multiple selections. Houston Ballet Academy maintains a policy of non-discrimination with regard to race, color, creed, religion, national origin, sexual preference, or non-job-related disability.

If your ethnicity is not listed above, please specify here.

All correspondence is sent via email to the Student and Primary email addresses.

Upload a ballet class headshot (does not need to be professional quality). Artistic and administrative staff will be viewing these photos to learn names.

- Males: white t-shirt with hair combed neatly.

Photo should be a JPEG file and no larger than 5000 KB.

Understanding vaccination rates helps Houston Ballet Academy make decisions that impact class size and schedule, among other aspects of the program. Students attending all workshops are recommended to be fully vaccinated for COVID-19. Students are considered fully vaccinated two (2) weeks after their last dose in a 2-dose
plus booster series, such as the Pfizer or Moderna vaccines, or two (2) weeks after a single-dose vaccine plus booster, such as Johnson & Johnson’s vaccine.

Photo should be a JPEG file and no larger than 5000 KB.

Parent/Guardian Information

Enter first and last name. Please include your preferred prefix.

All correspondence is sent via email to the Student and Primary email addresses. The Primary email address will receive all invoice notifications and login credentials for the Parent Portal. Please note that emails may go to the junk or spam folder.

Enter first and last name. Please include your preferred prefix.

Please select all that apply.

Please enter for first and last name of the emergency contact if you selected Other.

Policies and Agreements

I have read and agree to abide by the stated policies in the Student Handbook available on our website here.

I am the parent or legal guardian of the above student (my "Child"). Additionally, I acknowledge that my Child is currently enrolled at the Houston Ballet Academy, an educational institute for dance. I understand that my Child may suffer an injury or sickness during their enrollment with the Houston Ballet Academy and immediate medical care for my Child may be necessary.

If in the judgment of any representative of the Houston Ballet Academy my Child should need immediate medical care and treatment as a result of any injury or sickness, and I cannot be reached at the telephone contact provided as the primary and/or secondary phone number to give my consent, I do hereby authorize the Houston Ballet Academy and its representatives to consent for such medical care and treatment as may be given to my Child by any health care provider, physician, nurse, athletic trainer, or school representative.

This authorization shall remain effective throughout the term of my Child's enrollment with the Houston Ballet Academy unless it is earlier revoked by me in a written notice to the Houston Ballet Academy.

I am the parent or legal guardian of the above student (my "Child"). In consideration of my Child's opportunity to participate in the dance training, educational courses, instructional classes, recreational activities, and other activities (collectively, "Activities") offered at, by, or through the Houston Ballet Academy, I, on both my and my Child's behalf and on behalf of my Child's and my heirs, agents, successors, and assigns, hereby freely and voluntarily enter into this Parent/Guardian Waiver and Assumption of Risk and Release of Liability ("Waiver") in favor of the Houston Ballet Academy, the Houston Ballet Foundation, and each of the foregoing's respective affiliates, officers, directors, managers, members, trustees, employees, representatives, agents, instructors, staff, volunteers, independent contractors, successors, and assigns (collectively, the "Houston Ballet"). Accordingly, I hereby agree and acknowledge as follows:

I understand that my Child may engage in Activities at, by, or through the Houston Ballet that may be hazardous, that others, including but not limited to other students, visitors, instructors, employees, staff, volunteers, independent contractors, agents, and representatives of Houston Ballet, may also be engaging in these and other potentially hazardous activities and that their actions could pose a hazard to my Child, and that there is risk of injury inherent in all of these activities. I HEREBY SPECIFICALLY AND EXPRESSLY ASSUME THE RISK OF INJURY AND HARM TO MY CHILD RELATED TO THOSE ACTIVITIES AND ANY OTHER ACTIVITIES AT, BY, OR THROUGH THE HOUSTON BALLET, INCLUDING FOR INJURIES OR DAMAGES ARISING OUT OF OR ATTRIBUTABLE TO THE HOUSTON BALLET'S NEGLIGENCE.

I understand that this Waiver discharges the Houston Ballet from any and all liability or claim that I or my Child may have against the Houston Ballet for injury, illness, death, property damage, or other loss that may result from my Child's activities with the Houston Ballet.

I expressly agree that this Waiver is intended to be as broad and inclusive as permitted by the laws of the State of Texas, and that this Waiver shall be governed by and interpreted in accordance with the laws of the State of Texas. I agree that the exclusive venue for any dispute arising out of or related to this Waiver of the Released Claims is in state or federal court in Harris County, Texas. I agree that if any clause or provision of this Waiver is held to be invalid by any court of competent jurisdication, the invalidity of such clause or provision will not otherwise affect the remaining provisions of this Waiver, which continue be enforceable.

I express consent to my Child's participation in the Houston Ballet Academy's program and all Activities, and I further consent to my child's participation in other activities such as performances in connection with such program and the Houston Ballet.

To my knowledge, my Child does not have any medical problem(s) other than those that have been disclosed in writing to the Houston Ballet. If, between this date and the beginning of the Academy season, any illness or injury should occur that may limit the student's participation, I agree to notify the school authorities of such illness or injury in writing.

I represent that my Child is not now suffering from any physical or mental disability, which prevents them from dancing. I understand that continuing to dance may result in the aggravation of previous injuries and/or sustaining new injuries. I also fully understand that any or all of the injuries sustained while my Child is participating could result in future permanent disability. I fully understand the possible consequences of dance, desire for my Child to be permitted and cleared to dance, and hereby assume the risk of the matters set forth above. I understand that, should my Child by injured during the Houston Ballet Academy programming, a full release for all activities by a doctor may be required before my Child will be allowed to resume participation in the program.

I understand that the novel coronavirus (“COVID-19”) has been declared a worldwide pandemic by the World Health Organization and that it is extremely contagious and is believed to spread mainly from person-to-person contact. While the Houston Ballet Academy has put in place preventative measures to reduce the spread of COVID-19, I further acknowledge that Houston Ballet Academy makes no representation or warranty, either express or implied, that COVID-19 infection will not occur through participation in its programs.

I agree to follow any and all preventative measures that the Houston Ballet Academy, including staying home if I should experience any symptoms to COVID-19 or come into contact with anyone who is suspected of being infected by COVID-19.

Regardless of any steps taken by my family or the Houston Ballet Academy to reduce the risks associated with the COVID-19 pandemic, I am fully aware that there are risks associated with my attendance at Houston Ballet Academy during the COVID-19 pandemic, including without limitation, being exposed to and contracting COVID-19 from other individuals, surfaces and/or airborne particles. I understand that my contracting of COVID-19 could result in serious medical symptoms requiring medical treatment in a hospital or even death for me or some other member of my household.

On behalf of myself and my respective heirs, successors, and assigns, I knowingly and freely assume all such risks, both known and unknown, relating to my care at Houston Ballet Academy arising from or relating to COVID-19, including all illnesses, injuries, damages or death arising therefrom. I hereby forever release, waive, relinquish, and discharge Houston Ballet Academy and the Houston Ballet Foundation, along with their officers, directors, members, managers, officials, partners, trustees, agents, contractors, employees, affiliates, or other representatives, and their respective successors and assigns (collectively, the Houston Ballet Academy Representatives”), from any and all claims, demands, liabilities, rights, damages, expenses (including attorneys’ fees and costs), and causes of action of whatever kind or nature, and other losses of any kind, whether known or unknown, foreseen or unforeseen, (collectively, “Damages”) arising from or relating to COVID-19 as a result of my care at Houston Ballet Academy, and including but not limited to claims based on the alleged negligence or misconduct of any School Representative or any other person and including any alleged failure of any School Representative to take reasonable steps to safeguard me from the risks and hazards described hereinabove.

I further covenant not to sue Houston Ballet Academy or any School Representative for any illness, injury, death or other Damages arising out of or related to COVID-19 and agree to indemnify and hold them harmless from any and all Damages resulting therefrom as a result of my care at Houston Ballet Academy.

I am the parent or legal guardian of the above student (my "Child"). I consent to the disclosure of my Child's health information that the health care provider has in his or her possession and voluntarily authorize and direct the health care provider for my Child to use or disclose my Child's health information during the term of this Parent/Guardian Medical Information Release Authorization (the "Authorization") to the:

Houston Ballet Academy
601 Preston Street
Houston, TX 77002

This Authorization permits the health care provider to disclose to Houston Ballet Academy my Child's information relating to any medical history, mental or physical condition, and any treatment received by my Child. This Authorization shall supersede any prior agreement that I may have made with my Child's health care provider to restrict access to or disclosure of their individually identifiable health information, and any health care provider which acts in reliance on this Authorization is hereby released from liability that may result from disclosing any of my Child's health information. I understand that once my Child's health care provider discloses my Child's health information to the Houston Ballet Academy, my Child's health care provider cannot guarantee that the recipient will not re-disclose my health information to a third party. The third-party may not be required to abide by this Authorization or applicable federal and state law governing the use and disclosure of my Child's health information.

Furthermore, I understand that I may refuse or may revoke (at any time) this Authorization for any reason and that there are no exceptions to this right to refuse or revoke. Such refusal or revocation will not affect the commencement, continuation, or quality of my Child's treatment by my Child's health care provider.

This Authorization will remain in effect until the term of my Child's engagement with the Houston Ballet Academy expires, or I provide written notice of revocation to my Child's health care provider. The revocation will be effective immediately upon my Child's health care provider's receipt of my written notice.

If a student wishes to withdraw from the Peter Pan Boy's Workshops, the Registrar's Office must receive a completed withdrawal form. Houston Ballet Academy is not liable or obligated in any way to process any refunds or issue any tuition credits.

Houston Ballet Academy is dedicated to the treatment of all persons with respect and dignity and to providing an environment that is free from any form of discrimination or harassment. Houston Ballet Academy prohibits and will not tolerate harassment of any kind to or by any persons, including teachers, staff, students, parents/guardians, and any other person affiliated with or doing business with Houston Ballet Academy. This prohibition includes harassment for any unlawful discriminatory reason, such as race, gender, national origin, disability, age or religion. This policy also prohibits actions that, while they may not be so severe or serious as to constitute harassment in a legal sense, are nevertheless commonly understood to be abusive and disrespectful of others. Accordingly, slurs, jokes, or remarks that are derogatory of a person or group’s race, ethnic background, religion, gender, disability, sexual orientation, economic status or age are considered inappropriate for the Academy’s environment.

This policy extends not only to verbal harassment, but also includes online harassment or bullying.

Each person is responsible for exercising his or her own good judgment to avoid engaging in conduct that may violate this policy. A person who believes themself to be a victim of discrimination or harassment should report the incident to the Director of the Academy. The matter will be dealt with on a confidential basis with disclosure only to the extent necessary for fair problem resolution and only to those who have an immediate need to know.

In consideration of good and valuable considerations, the receipt of which is hereby acknowledged, I hereby grant to Houston Ballet, its nominees, designees, successors and assigns, or those for whom they are acting, the absolute right and permission to copyright, and/or use, and/or publish photographs, or videos of me or my child, or in which myself or my child may be included in whole or in part, or composite, or distorted in character or form, in conjunction with our own or any other picture or reproductions thereof made at its studios or elsewhere, for art, advertising, business or trade, news reporting, online use, social media, or any other lawful purpose whatsoever.

I hereby waive any right that I may have to inspect and approve the finished product or the advertising copy that may be used in connection therewith or the use to which it may be applied. I understand that there will also be no payment made to myself/or child for use of photos/videos (including speaking roles).

All media inquiries and requests for interviews and information must be referred to Houston Ballet’s Public Relations department. No dancer, student, parent, teacher, employee, staff member, or other person affiliated with Houston Ballet or the Houston Ballet Academy (HBA) should talk with a member of the media about Houston Ballet, the HBA or any individual associated with either organization, on or off the record, without prior authorization from the Public Relations department. All photographs taken of Houston Ballet or HBA students during Houston Ballet or HBA classes or photo sessions are the sole property of Houston Ballet. Occasionally, students are interviewed by journalists and media crews to promote activities of the Academy and Company. In my signing of this form I give permission for an indefinite period of time for my child, (myself if over 18), to be photographed, filmed, and/or interviewed in a Houston Ballet supervised environment for the sole purpose of promotions for the Academy and/or Company.

Only those employees officially designated by Houston Ballet are authorized to speak on behalf of the Company. Unless you have received permission from the Public Relations department, you should not in any way imply that your speech is approved or adopted by Houston Ballet, or that you speak in any official capacity for the Company.

However, Houston Ballet encourages all staff, Company Members, students and faculty to engage with, and create content for, Houston Ballet social media pages. All active social media participants, directly or indirectly representing the Houston Ballet brand, should be aware that Houston Ballet reserves the right to request the immediate removal of content that in any way relates to Houston Ballet, or the activities herein.

The use of material protected by copyright, trademark law, or other intellectual property rights without permission is prohibited. Examples of copyrighted material include, but are not limited to, Houston Ballet’s and Houston Ballet’s Academy’s logos, images (including, but not limited to, photos from performances, rehearsals, [practices] and Houston Ballet events, as well as marketing collateral), performance audio recordings, performance video footage, footage filmed on Houston Ballet property (including, but not limited to, the Center for Dance, the Wortham Theater Center, and the production warehouse), costume and scenic designs, choreography, video and audio produced by Houston Ballet and Houston Ballet Academy (including, but not limited to, podcasts), and materials written by Houston Ballet or Houston Ballet Academy (including, but not limited to, text from brochures, programs, and HB’s website).

Mandatory Fees
Peter Pan Boys Workshop September 2022 190
Total 190.00

Upload Image

To crop this image, drag a region below and then click "Save Image"