PDI 2027 - Brazilian Students - Victoria Academy of Ballet

PLEASE COMPLETE THIS FORM IN ENGLISH - Thank you!

Student First Name *

*AS IT APPEARS ON YOUR PASSPORT

Student Last Name *

*AS IT APPEARS ON YOUR PASSPORT

Student Preferred Name (if applicable)

*This is the name you want to be called.

Student Gender *

Student Pronouns *

Example: She/Her, He/Him, They/Them

Student Date of Birth *

Student Age *

Student Nationality

If you have more than one nationality, please separate countries with a semicolon (;).

Student Home Address *

Address Line 1

City

State / Province / Region

Zip / Postal Code

Country

Student Email *

Student Phone *

Passport/ID Upload

Drop your file here or click here to upload You can upload up to 1 files.

Please upload a scan of the data page of your passport. If you do not have a passport, please email admissions@vaballet.ca for further information.

Summer T-Shirt Size *

*Please make sure you are selecting the correct size as sizes cannot be adjusted.

PRIMARY PARENT/GUARDIAN INFORMATION

Primary Parent/Guardian First Name *

Primary Parent/Guardian Last Name *

Primary Parent/Guardian Home Address *

Address Line 1

City

State / Province / Region

Zip / Postal Code

Country

Primary Parent/Guardian Phone *

Primary Parent/Guardian Email *

SECONDARY PARENT/GUARDIAN INFORMATION

Secondary Parent/Guardian First Name

Secondary Parent/Guardian Last Name

Secondary Parent/Guardian Home Address

Address Line 1

City

State / Province / Region

Zip / Postal Code

Country

Secondary Parent/Guardian Phone

Secondary Parent/Guardian Email

*The Emergency Contact must NOT be the Primary Parent/Guardian. Please provide another contact.

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Relationship to Student *

*The Emergency Contact must NOT be the Primary Parent/Guardian.

Emergency Contact Phone *

Emergency Contact Email *

Who should be contacted FIRST in an emergency? *

Primary Parent/Guardian
Secondary Parent/Guardian
Emergency Contact

Who should be contacted SECOND in an emergency? *

Primary Parent/Guardian
Secondary Parent/Guardian
Emergency Contact

Current Dance School *

Years of Ballet Training *

Years of Pointe Work (if applicable)

Other Styles of Dance Training

If 'Other' please describe:

Do you require homestay accommodation provided by VAB? *

Yes
No

Following registration, students will receive a Medical History Form that will require further detail about their physical and mental health.

Do you have any medically diagnosed allergies? *

Yes
No

If 'Yes', please describe: *

Are you experiencing any major, on-going injuries? *

Yes
No

If 'Yes', please describe: *

Please describe any major health concerns:

I understand and agree that all payments for the Professional Dance Intensive are non-refundable and non-transferable. *

Yes (I Agree)

Date of Agreement *

Initial Payment *

Price: $ 1,560.00

*Includes 4% PayPal fee.

Total

360.00

Academy

Vocational Division

Open Division

Summer Programs

PDI 2027 – Brazilian Students

Professional Dance Intensive 2027

PLEASE COMPLETE THIS FORM IN ENGLISH - Thank you!

PRIMARY PARENT/GUARDIAN INFORMATION

SECONDARY PARENT/GUARDIAN INFORMATION

*The Emergency Contact must NOT be the Primary Parent/Guardian. Please provide another contact.

Following registration, students will receive a Medical History Form that will require further detail about their physical and mental health.

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