Application: Part 3

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All Competitors, Coaches, and Non-Competing Partners are required to complete the following form by April 16, 2023.

2023 Competitor, NCP, & Coach Application: Part 3 (FINAL)

"*" indicates required fields

Step 1 of 6

I am a:*

GENERAL INFORMATION

Name*

First Last

Native Language:*

Other Languages Spoken:

Do you need an interpreter:*

Interpreters can be provided for translation of orientation, documents, and more.

Date of Birth*

Age (as of June 10, 2023)*

Email*

Enter Email Confirm Email

Current Phone:*

Current Mailing Address:*

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

Name(s) of Competitors you are coaching:*

File*

Max. file size: 4 GB.

MEDICAL INFORMATION & RELEASE

Medical Information

If none, write "none"

I am currently taking the following medications:*

I am allergic to the following medications:*

Allergies:*

Specific Diet Restrictions (vegetarian, gluten-free, vegan, etc.):*

Notes (past injuries, conditions, etc.):*

Emergency Contact

Emergency Contact Name

First Last

Relationship:*

ex. Mother, Coach, Guardian, etc.

Emergency Contact Phone #*

Emergency Contact Email:

Participant Release

PLEASE PRINT THIS PAGE FOR YOUR RECORDS

Consent*

BY CHECKING THIS BOX, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND AND AGREE TO BE BOUND BY THE FOREGOING PROVISIONS, HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS ABOUT THE USA IBC AND THE PROVISIONS HEREIN, AND DESIRE TO ENTER INTO THIS AGREEMENT IN EXCHANGE FOR PARTICIPATION IN THE USA IBC.

USA International Ballet Competition

Release and Waiver of Liability, Assumption of Risks, and Indemnification Agreement

The USA International Ballet Competition, a Mississippi Non-Profit Corporation (“USA IBC”) provides a quadral-annual ballet competition. The Participant hereby agrees as follows:

Assumption of the Risks: The Participant is aware of, and understands the dangers and risks associated with dance in general, and the USA IBC in particular, and acknowledges that there are certain dangers and risks involved in any such ballet competition. Understanding these risks, the Participant, knowingly and voluntarily assumes any and all such risks and dangers which may arise out of or occur as a result of participant’s involvement in the Competition.

Additionally, I understand that with the USA IBC, as with any other activity, there is risk of possible transmission of and exposure to, the Covid 19 virus or other airborne illnesses. The Participant assumes all risks associated with possible transmission and exposure. The Participant also agrees to withhold themselves from any and all activities at any time the Participant exhibits a fever or other symptom commonly associated with the Covid 19 virus, and agrees to promptly advise Program staff of all such conditions or symptoms.

Furthermore, Participant releases the USA IBC it’s staff, board, agents, sponsors, providers of housing an facilities and other entity associated with Competition from any and all claims arising out of or associated with the Competition.

Absolute Release and Waiver: The undersigned hereby releases and waives any and all claims for any liability resulting from the USA IBC, including personal injury, property damage, illness and/or death arising out of, or in any way relating to the Participant’s involvement in the USA IBC. Such release and waiver shall apply to USA IBC, its officers, directors, employees, board members, and sponsors. The Participant acknowledges and assumes all risks and understands that this release and waiver applies to all claims arising out of Participant’s participation in the USA IBC.

Indemnification: The undersigned hereby indemnifies, defends and holds harmless the USA IBC, its officers, directors, employees, board members, and sponsors from any and all claims, civil actions, damages, expenses and liabilities, including attorney fees, arising out of Participant’s involvement in the USA IBC.

Photo & Video Release: The undersigned hereby grants the USA IBC permission for the permanent, unlimited use of any photo, film, videotape, or other recording made of the Participant while engaged in USA IBC, in any media whether now existing or existing in the future. The Participant’s name, likeness, and any other biographical information may be used by the USA IBC for any purpose.

Severability: The undersigned understands and acknowledges that the provisions herein are intended to be interpreted as broadly and inclusively as allowed under Mississippi law. To the extent that any provision herein shall be deemed void, voidable, or otherwise unenforceable, the remaining terms herein shall remain in full force and effect.

Electronic Signature

First Last

Guardian Electronic Signature (if Participant is under 18)

First Last

Date

REQUIRED COMPETITOR AND NCP INFORMATION:

I am competing as a:*

Division:*

Check this box if Couple is comprised of a Junior & Senior Competitor

Please type your name here, as it should appear in the program:*

Please type the name of your partner here, as it should appear in the program:*

Country Representing*

Country

ROUND I: CLASSICAL

SOLOIST: must select TWO classical variations from the Round I Classical Repertoire listed in the drop-down menus below. COUPLES: must select ONE pas de deux from the Round I Classical Repertoire listed in the drop-down menu below. Note - Couples comprised of a Junior and a Senior applicant must choose from the Junior repertoire for Round I of the competition. CHOREOGRAPHY should adhere as closely as possible to the original. If the choreography is altered, competitors must indicate whose it is in the choreographer space on this from; i.e. Fredick Ashton after Marius Petipa.

Soloists:

Junior Female Soloist Classical Variation #1:*

Select your FIRST variation for ROUND I

Junior Male Soloist Classical Variation #1*

Select your FIRST variation for ROUND I

Senior Female Soloist Classical Variation #1*

Select your FIRST variation for ROUND 1

Senior Male Soloist Classical Variation #1*

Select your FIRST variation for ROUND 1

Variation #1 Choreographer:*

Junior Female Variation #1 Music Track*

Junior Male Variation #1 Music Track*

Senior Female Variation #1 Music Track*

Senior Male Variation #1 Music Track*

Junior Female Soloist Classical Variation #2:*

Select your SECOND variation for ROUND I

Junior Male Soloist Classical Variation #2*

Select your SECOND variation for ROUND I

Senior Female Soloist Classical Variation #2*

Select your SECOND variation for ROUND I

Senior Male Soloist Classical Variation #2*

Select your SECOND variation for ROUND I

Variation #2 Choreographer:*

Junior Female Variation #2 Music Track*

Junior Male Variation #2 Music Track*

Senior Female Variation #2 Music Track*

Senior Male Variation #2 Music Track*

For Couples:

Junior Couple Selection*

Select ONE pas de deux for ROUND 1

Junior Couple Selection*

Select ONE pas de deux for ROUND 1

Senior Couple Selection*

Select ONE pas de deux for ROUND I

PAS DE DEUX Choreographer:*

Junior Pas de Deux Entreé Music Track*

Junior Pas de Deux Male Variation Music Track*

Junior Pas de Deux Female Variation Music Track*

Junior Pas de Deux Coda Music Track*

Junior Pas de Deux Coda Part II Music Track (if applicable)*

Senior Pas de Deux Entreé Music Track*

Senior Pas de Deux Male Variation Music Track*

Senior Pas de Deux Female Variation Music Track*

Senior Pas de Deux Coda Music Track (if applicable)*

Senior Pas de Deux Coda Part II Music Track (if applicable)*

ROUND II: CONTEMPORARY

*Semi-finalists must perform a contemporary solo or duet choreographed after 2010. Total stage time allowed is 5 minutes. Those choosing to appear as a couple may not include solo works in either their contemporary programs and must always appear with the same partner. *Competitors are responsible for and must provide to the USA IBC written permission for use of choreography for Round II and Round III contemporary pieces. Choreographic permissions, due on April 16, 2023, must be submitted via email to sberrylee@usaibc.com.

Title of Work:*

Choreogrpaher:*

Year Choreographed:*

Title of Music:*

Composer:*

Performance Time:*

Will the USA IBC be the premiere for your Round II contemporary work?*

Contemporary entries premiering at the 2023 USA IBC are eligible for a choreography award.

ROUND III: FINALS (Classical and Contemporary)

FOR SOLOISTS

*In Round III, you must choose one variation from List A and one variation from List B. You will preform Variation "A" first and Variation "B" second. In Round III, Juniors and Seniors choose from the same repertoire. *Choreography should adhere as closely as possible to the original. If the choreography is altered, competitors must indicate whose it is in the choreographer space on this form; i.e. Fredrick Ashton after Marius Petipa.

Female Soloist Classical Variation A*

Select your FIRST Variation from List "A" for ROUND 3

Male Soloist Classical Variation A*

Select your FIRST Variation from List "A" for ROUND 3

Variation A Choreographer*

Female Variation A Music Track*

Male Variation A Music Track*

Female Soloist Classical Variation B*

Select your SECOND Variation from List "B" for ROUND 3

Male Soloist Classical Variation B*

Select your SECOND Variation from List "B" for ROUND 3

Variation B Choreographer*

Female Variation B Music Track*

Male Variation B Music Track*

FOR COUPLES:

Couples must perform one classical pas de deux. In Round III, Juniors and Seniors choose from the same repertoire.

Round 3, Pas de deux*

Select ONE Pas de Deux for ROUND 3

Pas de deux Choreographer:*

Pas de Deux Entreé Music Track*

Pas de Deux Male Variation Music Track*

Pas de Deux Female Variation Music Track*

Pas de Deux Coda Music Track*

Pas de Deux Coda Part II Music Track (if applicable)*

Round III Contemporary Work

*Finalists must perform a contemporary solo or duet choreographed after 2010. Total stage time allowed is 5 minutes. Those choosing to appear as a couple may not include solo works in their contemporary programs and must always appear with the same partner. *Competitors are responsible for and must provide to the USA IBC written permission for use of choreography for Round III contemporary pieces. Choreographic permissions, due on April 16, 2023, must be submitted via email to sberrylee@usaibc.com.

Title of Work:*

Choreographer:*

Year Choreographed:*

Title of Music:*

Composer:*

Performance Time:*

Will the USA IBC be the premiere for your Round III contemporary work?*

Contemporary entries premiering at the 2023 USA IBC are eligible for a choreography award.

TRAVEL INFORMATION

Passport Information

(If traveling within the United States, please write N/A)

Country of Origin:*

Country

Passport Number:*

I will be applying for a B2 Visa:*

Housing Request:

Name of Roommate Requested:*

*You may ONLY request a room with the same-gender competitor or non-competitor partner

2023 Competitor, NCP, & Coach Application: Part 3 (FINAL)

GENERAL INFORMATION

MEDICAL INFORMATION & RELEASE

Medical Information

Emergency Contact

Participant Release

REQUIRED COMPETITOR AND NCP INFORMATION:

ROUND I: CLASSICAL

Soloists:

For Couples:

ROUND II: CONTEMPORARY

ROUND III: FINALS (Classical and Contemporary)

FOR SOLOISTS

FOR COUPLES:

Round III Contemporary Work

TRAVEL INFORMATION

Passport Information

Housing Request:

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