SD I-III Program Registration Form

Summer Dance Academy 2024 - Personal Information & Emergency Contact Information

Select Your Program*
- Summer Intensive I
- Summer Intensive II
- Summer Intensive III
- Summer Intensive IV
- Summer Intensive IV/Junior Company Split
- Junior Company
Summer Intensive I Program Selection*
- July 4th-7th
- August 20th-23rd
All program dates, fees, schedules and program format is subject to change.
Summer Intensive II Program Selection*
- August 6th-10th
- August 12th-16th
- August 6th-August 16th
All program dates, fees, schedules and program format is subject to change.
Summer Intensive III Program Selection*
- August 6 - August 16
All program dates, fees, schedules and program format is subject to change.
Summer Intensive IV Program Selection*
- July 1st-July 5th
- July 1st-July 19th
- July 1st-August 2nd
All program dates, fees, schedules and program format is subject to change.
Summer Intensive IV/Junior Company Split Program Selection*
- June 17th-August 2nd
- June 23rd-August 2nd
All program dates, fees, schedules and program format is subject to change.
Junior Company Program Selection*
- June 17th-July 27th
All program dates, fees, schedules and program format is subject to change due to the ongoing COVID-19 pandemic. We are excited to return to in person Summer Programs this year! Due to the ongoing COVID-19 pandemic we are prepared to run the program in person, online or a combination of both. Our primary concern is the health and safety of our community, and we look forward to providing quality training no matter the format of the program. The program will take place at George Brown College – Casa Loma Campus in the CBJ studios. The schedule is made up of a variety of classes, including ballet, pointe, contemporary, composition, repertoire, and coaching.
Will you require residence?*
- Yes
- No
Please Note: We do not offer residence for Summer Intensive I students.
Student Information
Your Legal Name in Full*
First Middle Last
Date of Birth*
MM slash DD slash YYYY
Age as of today:*
Gender*
- Male
- Female
- Non-Binary
- Prefer not to say
Pronouns
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone Number*
Mobile Number
Primary Email Address:*
Secondary Email Address:
Health Information
Do you have any or have you incurred any recent injuries?*
- Yes
- No
If yes - please list:*
Do you have any allergies (dietary, seasonal, medical etc.)*
- Yes
- No
Please list your allergies and potential reactions here:*
Health Card Number:*
Province where health card was issued:*
Insurance Company:*
Policy Carrier:*
Policy Number:*
re you taking any medication(s)? If yes, please list and indicate if student needs help with administration. If no, please write down N/A:*
During Program Emergency Contact
Parent/Guardian Name*
First Last
Phone Number*
Email Address:*
Emergency Contact Name*
First Last
Phone Number*
Emergency Contact Relationship:*
Residence Registration
We are in the process of confirming residence details however in the past we have worked with Victoria College and York University. Check-in is at 4pm on the day before your program start date and check-out is at 11am on the day after your program end date. Should you require a different check-in or check-out date please contact auditions@balletjorgen.ca
Would you like to stay in a single or double room?*
- Single Room
- Double Room
- No preference
Please note: We will do our best to accommodate all requests and will notify you if we cannot.
If you selected a double room, is there someone you would like to room with?

Please note that each dancer must select the double room option and identify that they would like to room together in order for roommate requests to be accommodated.
Would you like to like access to the dining hall for dinner?
- Yes
- No
Please note that dinner is an extra charge on top of your room charge. All residents receive breakfast in the dining hall as part of your residence fees.
Do you anticipate needing the Airport Pick-up/Drop-off service?
- Yes
- No
Please note that airport pick-up and drop-off is confirmed upon receipt of payment.
Waiver of Liability & Policy Consent
Student Name*
First Last
Parent/Guardian Name*
First Last
If the Student is under the age of 18, this waiver & policy must be consented to by a parent or legal guardian.
Waiver of Liability Consent (required)*
I agree to CBJ's Waiver of Liability
In Consideration of Jörgen Dance accepting the Student into 2023 Summer Intensive Program, the undersigned hereby waives any claims to which undersigned may become entitled for injury or damage and releases Canada’s Ballet Jörgen, its employees, officers and directors and teachers in the Program, from any claims for injury or damage the Student may suffer or incur while participating in the Program.
Appropriate Physical Contact in Dance Policy (required)*
I have read and understood Jörgen Dance Academy's Appropriate Physical Contact in Dance Policy
Please view the policy at the top of this page.
Jörgen Dance & George Brown Dance Photograph and Electronic Media Release Form (optional)
I agree to Canada’s Ballet Jörgen & George Brown Dance Photograph and Electronic Media Release Form
I/We [Parent/Legal Guardian listed above] hereby irrevocable grant to Jörgen Dance & George Brown Dance the non-exclusive right to use and incorporate, along or together with other materials, in whole or in part, screen shots or screen recordings taken of [Student Name listed above] as a Result of my participation in Canada’s Ballet Jörgen & George Brown Dance. I/We agree that these MATERIALS will be the exclusive property of Canada’s Ballet Jörgen & George Brown Dance, and that all reproduction rights are handed over to Canada’s Ballet Jörgen & George Brown dance to use the MATERIALS in such medium as brochures, flyers, poster, web sites in perpetuity.

Those who do not wish to be recorded or photographed during virtual Zoom classes will turn off their camera when notified of a screen shot or screen recording.

I/We understand that in signing this release in duplicate that there will be no compensation or remuneration for the use of these MATERIALS and there is no guarantee that they will be use.
I am:
- 18 years of age or older as of today's date.
- The Parent(s)/Guardian(s) of [Student Name as listed abov] and can therefore legally act on her/his behalf.
Today's Date
MM slash DD slash YYYY
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Summer Dance Academy 2024 - Personal Information & Emergency Contact Information

Student Information

Health Information

During Program Emergency Contact

Residence Registration

Waiver of Liability & Policy Consent