Joffrey Ballet School | Summer Pre-Check In – Official School in New York City

Summer Pre-Check In Form – Official

1Dancer Info

2Parent/Guardian + Emergency Information

3Intensive Information

4Medical/Health History & Clearance Information

5Sign & Submit

Dancer Pre-Check In

You will only need to Pre-Check in once!

If your dancer is attending more than one intensive:
• Housing students attending more than 1 program may complete 1 check-in for all intensives.
• Commuter dancers attending more than 1 program may complete 1 check-in for all intensives.
• Students attending more than 1 program who are using Joffrey housing AND commuting may complete 1 check-in (please complete the housing check-in information)

Before you begin, please have the following information ready for upload;

For all dancers:
• Insurance Information (if applicable)
• Medication Information
• Doctors note of clearance to attend: (Please provide a copy of a doctor’s note giving health clearance for your dancer’s attendance. In the body of the letter, simply have the doctor state that the dancer is healthy to participate in the summer program. Please note, a health physical of your dancer from the doctor’s office is not necessary.) Please click here for sample doctors note

Pre-Check In should be completed by:
• Housing Students: 1 week (7 days) before your arrival
• Commuter Students: 1 week (7 days) before your arrival

Pre-Check In Submission Info

You will receive a copy of your completed questionnaire and documents via email. If you would like to update your information after submission, please email us at support@joffreyballetschool.com.

Dancer Info

Dancer Name(Required)

First Last

Dancer Email(Required)

Parent Email(Required)

Dancer Phone Number(Required)

Dancer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Dancer Date of Birth(Required)

YYYY

Dancer Age by June 1st, 2025(Required)

Is your dancer 17 years or younger?(Required)

What is your sex?(Required)

Female

Male

What is your Gender Identity?(Required)

Female

Male

Non-Binary

Prefer Not to Say

Pronouns(Required)

She/Her

He/Him

They/Them

Other

Dancer Language of Preference(Required)

Dancer Leotard/Dancewear Size(Required)

Youth Small

Youth Medium

Youth Large

Youth Extra Large

Adult Extra Small

Adult Small

Adult Medium

Adult Large

Adult Extra Large

Sizing will be used for costuming for those dancer’s who will be attending a performance week during their intensive.

Parent Info

Parent/Guardian Info(Required)

Dancer is in the custodial care of:

Both Parents

Mother Only

Father Only

Other

Parent/Guardian 1 Name(Required)

First Last

Parent/Guardian 1: Email(Required)

Must be different than dancer email

Parent/Guardian 1: Phone(Required)

Parent/Guardian 2: Name(Required)

First Last

Parent/Guardian 2: Email(Required)

Must be different than dancer email

Parent/Guardian 2: Phone(Required)

Emergency Contact Info

Same as parent info

Emergency Contact #1(Required)

First Last

Emergency Contact #1 Phone(Required)

Emergency Contact #1 Relationship(Required)

Emergency Contact #2(Required)

First Last

Emergency Contact #2 Phone(Required)

Emergency Contact #2 Relationship(Required)

Intensive Info

Select dancer intensive(s)(Required)

Please select all registered intensive

Joffrey Akron

Joffrey Cirque Arts Las Vegas

Joffrey Colorado

Joffrey Dallas

Joffrey Italy

Joffrey Las Vegas (Ballet)

Joffrey Las Vegas (Jazz & Contemporary)

Joffrey Miami (Ballet)

Joffrey Miami (Jazz & Contemporary)

Joffrey Midwest

Joffrey San Francisco

Joffrey South (Ballet)

Joffrey South (Jazz & Contemporary)

Joffrey Switzerland

Joffrey West

JoffreyRED (Contemporary Ballet)

NYC Ballet Intensive

NYC Hip Hop Intensive

NYC Jazz & Contemporary Intensive

NYC Musical Theater Intensive

NYC Pre-Professional Ballet Intensive

NYC Pre-Professional Contemporary Intensive

NYC Pre-Professional Jazz & Contemporary Intensive

NYC Tap Intensive

Please select if you are a:(Required)

Housing Student

Commuter Student

Did you purchase a Meal Plan(Required)

Yes

Any dietary modifications (vegetarian/vegan/lactose free, etc)?(Required)

Yes

Explain any dietary modifications (vegetarian/vegan/lactose free, etc):(Required)

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COVID-19

For Summer 2024 COVID-19 Vaccination is NOT required to attend any Joffrey Ballet School Intensive. Masks are optional at ALL programs.

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Have you been vaccinated for COVID -19 ?(Required)

Yes

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If Yes, please upload your immunization card below(Required)

Accepted file types: jpg, png, pdf, doc, Max. file size: 4 MB.

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COVID-19 Test

COVID-19 Tests are not required to attend the program.

Health History and Information

Highly recommended vaccines to discuss with doctor before attending:

– MMR (Measles, Mumps, Rubella)
– DTap or Tdap (Diptheria, Tetanus, Acellular Pertussis)
– MCV4/Menactra/Menveo (Meningococcal Disease/Meningitis)
– Hepatitis A & B Vaccinations
– Covid-19 Vaccine
– IPV (Inactivated Polio Vaccine)

Vaccines recommended to consider/discuss with healthcare provider based on age:

– Varicella/Chickenpox Vaccine
– Gardasil (Human Papillomavirus HPV Vaccine)
– PPV/Influenza (Pneumococcal Polysaccharide Vaccine)

Are all immunizations current?(Required)

Yes

If No, please state reason(s):(Required)

Tetanus Date:

Optional

YYYY

Any allergies?(Required)

Yes

Food(Required)

Yes

Stings(Required)

Yes

Plants/Trees(Required)

Yes

Medications(Required)

Yes

Other(Required)

Yes

Please specify allergies(Required)

Explain “yes” answers. Include the type of allergy. (e.g. – “nut allergy” in the food category)

Do any of the following apply to your child?(Required)

Specific needs or accommodations required

Behavior and/or Mental Health history

Psychiatric counseling or hospitalization

Operations or serious injuries

History and/or treatment of eating and feeding disorders

None of the above

Prefer Not To Say

Specific needs or accommodations:(Required)

Please explain in detail

History and/or treatment of eating and feeding disorders(Required)

Please explain in detail

Behavior and/or mental health history:(Required)

Please explain in detail

Explain any psychiatric counseling, self-harm history, or hospitalization:(Required)

Please explain in detail

Operations or serious injuries:(Required)

Please explain in detail

Are any prescription medications being taken?(Required)

Yes

How many prescription medication is being taken?(Required)

If your dancer takes more then 3 prescription medications please send a complete list to health@joffreyballetschool.com. List the following information: Name of Medication, Reason for Medication, Dosage & Frequency

Name of Medication #1(Required)

Reason for Medication #1(Required)

Dosage #1(Required)

Frequency #1(Required)

Name of Medication #2(Required)

Reason for Medication #2(Required)

Dosage #2(Required)

Frequency #2(Required)

Name of Medication #3(Required)

Reason for Medication #3(Required)

Dosage #3(Required)

Frequency #3(Required)

Are any of the following used?(Required)

EpiPen

Inhaler

N/A

Insurance Information

Do you have Insurance?

Yes

Insurance Company(Required)

Policy Number(Required)

Policy Holder(Required)

Insurance Providers Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Insurance Provider's Phone Number(Required)

Primary Care Information

Optional

Primary Care Doctor

Primary Care Doctor Phone

Primary Care Doctor Email

Please enter a valid email, if you don’t have it please leave the field blank

Primary Care Doctor Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Health & Medical Authorization

I certify that all of the above is true and accurate. I understand that if I have provided false, misleading, or incomplete information the student may be immediately removed from the dormitory and/or program without refund of any fees. This health history is correct so far as I know. I/We, the undersigned, parents/legal guardians of (the “Minor”), a minor, do hereby authorize (the “Agent”), on behalf of the undersigned, to consent to the surgical, dental and/or medical examination or treatment of the Minor. Such treatment may include, but is not limited to, the following: transportation by ambulance, examination, xrays and other diagnostic procedures, any diagnoses, hospitalization, anesthesia, surgery, medication, and/or transfusion of blood or blood products. Agent may have access to any and all records, including, but not limited to, insurance records regarding any such services. t is understood that this Authorization is given in advance of any specific diagnosis, treatment, or hospital care being required, but is given to provide authority and power on the part of our aforesaid Agent to give specific consent to any and all such diagnoses, treatment, or hospital care which the physician or other caregiver may in the exercise of their best judgment may deem advisable.

This Authorization shall be effective beginning on June 1st and ending on August 23rd unless sooner terminated in writing.(Required)

I agree

Medical Clearance Form

I/We hereby authorize and acknowledge the following:(Required)

My child is in good mental and physical health to participate in the summer intensive(s)

Upload doctors note of clearance to attend:(Required)

(Mandatory for All Students) Please ensure your documents are less than 1MB. If it is bigger than 1MB, Please click here and resize your document:https://smallpdf.com/pdf-converter

Please click here to see an attachment of a sample doctor’s note.

Accepted file types: jpg, png, pdf, doc, Max. file size: 4 MB.

Signatures & Submission

Signatures Required

• Health and Medical Authorization Forms
• Waivers & Policies Forms

I understand that I will be redirected upon submission to sign the above forms and will need to complete all required signatures.

Dancer Electronic Signature(Required)

Parent/Guardian Electronic Signature(Required)

Unique ID

Today's Date(Required)

MM slash DD slash YYYY

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