St. Louis Juilliard Dance Experience April 2026

Student Information

Student First (Given) Name

Student Last (Family) Name

Student Preferred First Name (only if different from Given Name)

Pronouns (optional)
Please view our pronoun definitions

If other, please list pronouns below (optional)

Primary Email Address for Communications

Student Phone Number (optional):

Mailing Address

Country

Street

City

Region

Postal Code

Birthdate

Parent/Legal Guardian Information

Parent/Legal Guardian Type

Parent/Legal Guardian First Name:

Parent/Legal Guardian Last Name:

Parent/Legal Guardian Email:

Parent/Legal Guardian Phone Number:

End of Day Travel Plan

Please share the contact information of the person who will be responsible for the pick up of your Dance Experience Day participant below:

First Name:

Last Name:

Email:

Phone Number:

My child has my permission to leave the Juilliard Dance Experience Day on their own.

Dance Information

Dance Studio (optional):

Teachers(s) (optional):

Studio Address (optional):

Country

Street

City

Region

Postal Code

Studio Email (optional):

Studio Phone Number (optional):

Are you interested in learning more about The Juilliard School?

Yes

No

Are you interested in studying dance at the college or conservatory level?

Yes

No

Not Sure

Department (Hidden)

Major (Hidden)

Program (Hidden)

Emergency Contact

First Name:

Last Name:

Phone Number:

Email:

Relationship to the Student:

Secondary Emergency Contact First Name:

Secondary Emergency Contact Last Name:

Secondary Emergency Contact Phone Number:

Secondary Emergency Contact Email:

Secondary Emergency Contact Relationship to the Student:

Medical Information

Do you require an EpiPen?

Yes

No

Do you have a history of Asthma?

Yes

No

If yes, do you require an inhaler?

Yes

No

A sandwich, wrap, and salad buffet will be provided for lunch, including a vegetarian option. Do you have any dietary restrictions or food allergies we should be aware of? If so, please list them below. If not, please write "N/A".

*Please note that if you have specific dietary needs indicated on this form that we cannot accommodate we will be in touch to encourage you to bring your own lunch.

Is there anything else you'd like us to know? (Optional):

Registration Information

Are you applying for financial aid?

Yes

No

A limited amount of financial aid is available to eligible applicants who can demonstrate significant financial need. To be considered for financial aid, please enclose a letter explaining your financial situation.

The letter should include the following:

Household Income
Number of People
Any additional circumstances you'd like us to consider

Decisions for financial aid awards will be sent by March 10.

Financial Aid Letter

Consent, Waiver, and Release

PLEASE READ CAREFULLY

I am the parent or legal guardian of the participant, and I hereby give permission for my child to participate in the Juilliard Dance Experience Day (the “Program”) taking place at The Center of Creative Arts (“COCA”) on April 4, 2026. In consideration of my child’s participation in the Program, I hereby acknowledge and agree to the following:

1. I represent and warrant that: (a) I willingly sought permission for my child to participate in the Program; (b) my child is physically fit to participate in the Program and has no known medical or physical conditions that would impede participation; and (c) I have not been advised otherwise by a medical professional. I agree that my child will comply with all health and safety protocols imposed by Juilliard and COCA, including without limitation all COVID-19 safety requirements that may be in place during the Program.

2. I acknowledge and fully understand that my child may be engaging in activities that involve risk of serious injury, including without limitation disability and death. These risks include, but are not limited to, those caused by: (a) the actions, inactions or negligence of The Juilliard School, students, faculty, participants, volunteers, guests and other third parties; (b) the conditions of the premises or equipment used, if any; and (c) possible exposure to COVID-19 or other infectious diseases. I further acknowledge and fully understand that there may also be other risks that are not known or foreseeable at this time. I KNOWINGLY AND VOLUNTARILY ASSUME ALL SUCH RISKS, AND I ASSUME FULL RESPONSIBILITY AND LIABILITY FOR MY CHILD’S PARTICIPATION IN THE PROGRAM.

3. With knowledge of the risks involved, and to the maximum extent permitted by law, I, on behalf of myself and my child, my heirs, executors, administrators and assigns, hereby waive, release, and discharge Juilliard, COCA, its administrators, trustees, officers, employees, students and agents (collectively the “Releasees”) from any and all claims for damages, injuries, losses, liabilities and expenses which my child or I may have or which may subsequently accrue to my child or me, relating to, resulting from or arising out of my child’s participation in the Program (collectively, “Claims”). I agree to indemnify, defend and hold the Releasees harmless from and against any and all such Claims.

4. I hereby grant permission to Juilliard and others acting on its behalf to use my child’s image and/or live or recorded audio and/or video (collectively, “Recordings”) for advertising and promotional purposes consistent with or in furtherance of Juilliard’s educational mission without my or my child’s further consent. I hereby waive any right that I now have or may have in the future to inspect or approve the Recordings or any materials that may be used in connection with the Recordings. I understand that Juilliard is under no obligation to provide any form of compensation or communication to me or anyone else for use of the Recordings as set forth herein. Juilliard is permitted, but not obligated, to include my child’s name as a credit in connection with the Recordings.

5. I, on behalf of myself and my child, hereby waive, release and discharge Juilliard from any claims related to defamation, invasion of privacy, rights of publicity, copyright or any other legal or financial responsibility that may arise regarding use of the Recordings as set forth herein.

6. I intend that this Consent, Waiver & Release of Liability shall be construed broadly to provide a waiver and release to the maximum extent permissible under applicable law. This Consent, Waiver & Release and any disputes arising hereunder shall be governed by and construed under the laws of the State of New York. The parties hereto hereby agree that any legal suit, action or proceeding arising out of or relating to this agreement must be instituted in a federal or state court located in the State of New York and hereby irrevocably submit to the jurisdiction of any such court.

I have fully read this Consent, Waiver & Release of Liability, understand its terms and impact, and am signing it voluntarily. I understand that my signature below represents my acceptance of the foregoing terms, and I certify that I am the parent or legal guardian of the minor named below and have the legal right to consent to these terms.

Student's Full Name:

Parent/Legal Guardian's Name:

Parent/Legal Guardian Electronic Signature:

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Payment

Full payment (Hidden calculation field)

Please submit payment of $300 for participation in the Juilliard Dance Experience.

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Financial Aid: Limited scholarship awards are available to cover either 50 or 100 percent of the tuition. Awards are based on need and are decided at the discretion of The Juilliard School upon review of your submitted materials. Decisions for financial aid awards will be sent by March 10. Payment is required within three (3) business days of receiving your award decision in order to hold your place.